Volume Number
121 3. Part
LA volume by ZDEICine CT
1
Calculation of LA volume by two-dimensional echocardiography has the advantage of being noninvasive, repeatable, and easily performed. Given the close correlation we have found between two-dimensional echocardiography and Cine CT, a more accurate method of volume determination,we have shown that echocardiography gives a valid, albeit a 23% underestimation, of LA volume measurements. The measurement is reliable over a wide range of volumes. The inaccuracies of echocardiographic measurement of the left atrium can be limited by maximizing LA size during scanning. The publication costs of this article by contributions made in the memory family and friends.
were generously supported of Elizabeth Nestel by her
REFERENCES
1. Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atria1 volume estimation by two-dimensional echocardiography. Cathet Cardiovasc Diagn 1981;7:165-78. 2. Ringertz HG, Rodgers B, Lipton MJ, Cann C, Carlsson E. Assessment of human right ventricular cast volume by CT and angiography. Invest Radio1 1985;2&29-32.
3. Mahoney LT, Smith W, Noel MP, Florentine M, Skorton DJ, Collins SM. Measurement of right ventricular volume using tine computed tomography. Invest Radio1 1987;22:451-5. 4. Goerke RJ, Carlsson E. Calculation of right and left cardiac ventricular volumes: method using standard computer equipment and biplane angiograms. Invest Radio1 1967:2:360-7. 5. Rees MR, Feirney Ax Rumberger JA, MacMillan RM, Clark DL. Heart evaluation by Cine CT: use of two new oblique views. Radiology 1986;159:804-6. 6. Silverman NH, Ports TA, Snider AR, Schiller NB, Carlsson E, Heilbron DC. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons. Circulation 1980;62:548-57. 7. Gutman J, Wang YS, Wahr D, Schiller NB. Normal left atria1 function determined by two-dimensional echocardiography. Am J Cardiol 1983;51:336-40. 8. Hiraishi S, Di Sessa TG, Jarmakani JM, Nakanishi T, IsabelJones J, Frieman WF. Two-dimensional echocardiographic assessment of left atria1 size in children. Am J Cardiol 1983; 52:1249-57. 9. Wahr D, NB. Left ventricular volumes . . Yin . . SW, . .Schiller determined by two-dtmensional echocardiography in a normal adult population. J Am Co11 Cardiol 1983;1:863-8. 10. Himelman RB, Cassidy M, Landzberg J, Schiller NB. Reproducibility of quantitaive two-dimensional echocardiography.
AM HEART J 1988;115:425-31
Effects of aging on left ventricular function
structure
and
To better characterize the cardiac structural and functional changes that are associated with aging, Doppler-echocardiography was performed on 23 young (mean age, 25 years) and 30 old (mean age, 70 years) healthy normotensive subjects. Left ventricular cavity dimensions and wall thickness were determined and left ventricular mass index was calculated from M-mode echocardiograms. Stroke volume was calculated from Doppler-measured aortic flow. Diastolic filling was evaluated by pulsed Doppler echocardidgraphy of mitral inflow. Posterior wall thickness (1.0 vs 0.8 cm, p < 0.05) and relative wall thickness (0.42 vs 0.35, p < -05) were significantly greater in the elderly subjects compared with the younger subjects. Left ventricular mass index increased on average 0.25 gm/m2/yr but was not significantly increased in the elderly compared with the younger subjects (89 vs 77 gm/m2). Shortening fraction and stroke volume did not differ between the two groups. Diastolic filling was dramatically altered with aging, and the elderly subjects demonstrated a doubling of percent atrial contribution (37% vs 19%, p < 0.0001) and halving of peak early-to-peak atrial velocity ratio (0.85 vs 1.77, p < .Ol). AM HEART
J 1991;121:871.)
Anthony C. Pearson, MD, Chalapathirao Arthur J. Labovitz, MD. St. Louis, MO.
V. Gudipati,
From the Department of Internal Medicine, Division of Cardiology, St. Louis University Medical Center, St. Louis, Mu. Received for publication July 16, 1990; accepted Sept. 1, 1990. Reprint requests: Anthony C. Pearson, MD, Division of Cardiology, The Ohio State University, 657 Means Hall, 1654 Upham Dr., Columbus, OH 43210. Q/1/26478
MD, and
The elderly represent the most rapidly growing group in the nation. Over 5500 individuals reach their sixty-fifth birthday each day. As the number and the proportion of elderly individuals in the population increases, knowledge of normal morphologic and physiologic changes that accompany aging becomes 871
872
Pearson, Gudipati,
and Labovitz
Table
I. Clinical characteristics Elderly
n Age (yr)
Sex(F/M) BSA (m2) Heart rate (beats/min)
30 70 * 5 16114 1.8 * 0.2 67 ? 8
American
Young 23 25 + 5 1617 1.9 * 0.2 72 ?I lO*
BSA, Body surface area. *p < 0.05.
increasingly important. Although the diastolic functional changes that are associated with aging have been well characterized, the effect of aging on normal systolic function and left ventricular mass is less clear. Therefore we used Doppler echocardiography to identify the morphologic and functional changes that are related to aging in a group of normotensive, community-dwelling, elderly volunteers. METHODS Study group.
The study population consisted of two groups of normotensive subjects (1) healthy, elderly individuals age65 or older and (2) young individuals age35 or younger. All the subjectswere volunteers who were free of symptoms and had no evidence of coronary artery disease, congestive heart failure, hypertension, or valvular heart diseaseby history, physical examination, and two-dimensionaland Doppler echocardiographicexaminations. None of them were taking any medications.All the subjectswere community-dwelling and physically active. Ultrasound studies. All subjects underwent complete M-mode, two dimensional,and Doppler echocardiography with commercially available ultrasound units with transducer frequencies of 2.0 to 3.5 mHz. Standard views were used from parasternal and apical windows. M-mode and Doppler echocardiogramswererecorded on hard copy at 50 to 100mm/set under two-dimensional guidance.According to the recommendations of the American Society of Echocardiography,l the thickness of the posterior wall and interventricular septum, the left ventricular end-diastolic and end-systolic dimensions,and the left atria1 and aortic sizes were measuredfrom M-mode echocardiograms.All appropriate measurementswere indexed to the body surface area, and thus left ventricular end-diastolic and endsystolic dimension indices, and left atria1 index were obtained. The left ventricular mass(LVM) wascalculated with an anatomically validated formula2 and with left ventricular end-diastolic dimension (LVEDD) and septal (VS) and posterior wall thickness (PW). LVM = 0.8 (1.04 {LVEDD + PW + VS)3 - (LVEDD)3}) + 0.6 gm. Left ventricular masswasdivided by the body surface area to calculate left ventricular mass index in grams/per square meter. Relative wall thicknesswasdetermined as:posterior wall thickness x2/LVEDD. The interventricular septum and posterior wall during the cardiac cycle were digitized with the use of custom-madesoftware, and the maximum
March 1991 Heart Journal
rate of changein left ventricular internal diameter during diastole (maximum DD/DT) and during systole (velocity of circumferential fiber shortening) were measured, For mitral inflow recordings,Doppler examinationswere performed with the transducer held at the cardiac apex to visualize the apical four-chamber view. In pulsedmode,the Doppler beamwasaligned parallel to the presumedmitral inflow, and the samplevolume wasplacedjust on the ventricular side of the mitral anulus. Velocity recordings of 5 consecutivebeats were chosenfor analysis and the results were averaged. Analysis. Measurementswere made on a digitizing pad connected to microcomputer and custom-made software wasused. The time from the onset of mitral inflow to the end of mitral flow wasthe diastolic filling period. The peak early and the peak atria1 velocities, integrals, and their ratios were measured.The one-third filling fraction was determined by dividing the areaunder the curve at one third of diastole by the total area under the curve. The percent atria1 contribution to left ventricular filling was determined by dividing the area under the portion of the mitral inflow tracing that occurred during atria1 systoleby the total area under the curve. Left ventricular outflow velocities were obtained from the apical five-chamber view. In the pulsed mode, the Doppler beam was aligned parallel to the presumed left ventricular outflow, and the samplevolume wasplacedjust on the ventricular sideof the aortic valve. Velocity recordingsof 5 consecutivebeatswere chosenfor analysisand the results were averaged.From the hard copy recordingswith custom-madesoftware, the peak velocity, the mean velocity, the acceleration time (time to reach the peak velocity), mean acceleration index (the peak velocity/acceleration time), and flow velocity integrals were measured.Cardiac output wascalculated by multiplying the flow velocity integral times the heart rate and the cross-sectionalarea of the left ventricular outflow tract. Statistics. All results were expressed as mean it SD. Significance wascomputed with Student’s two-tailed, unpaired t test. A p value
121 3. Part
LA volume by ZDEICine CT
1
Calculation of LA volume by two-dimensional echocardiography has the advantage of being noninvasive, repeatable, and easily performed. Given the close correlation we have found between two-dimensional echocardiography and Cine CT, a more accurate method of volume determination,we have shown that echocardiography gives a valid, albeit a 23% underestimation, of LA volume measurements. The measurement is reliable over a wide range of volumes. The inaccuracies of echocardiographic measurement of the left atrium can be limited by maximizing LA size during scanning. The publication costs of this article by contributions made in the memory family and friends.
were generously supported of Elizabeth Nestel by her
REFERENCES
1. Schabelman S, Schiller NB, Silverman NH, Ports TA. Left atria1 volume estimation by two-dimensional echocardiography. Cathet Cardiovasc Diagn 1981;7:165-78. 2. Ringertz HG, Rodgers B, Lipton MJ, Cann C, Carlsson E. Assessment of human right ventricular cast volume by CT and angiography. Invest Radio1 1985;2&29-32.
3. Mahoney LT, Smith W, Noel MP, Florentine M, Skorton DJ, Collins SM. Measurement of right ventricular volume using tine computed tomography. Invest Radio1 1987;22:451-5. 4. Goerke RJ, Carlsson E. Calculation of right and left cardiac ventricular volumes: method using standard computer equipment and biplane angiograms. Invest Radio1 1967:2:360-7. 5. Rees MR, Feirney Ax Rumberger JA, MacMillan RM, Clark DL. Heart evaluation by Cine CT: use of two new oblique views. Radiology 1986;159:804-6. 6. Silverman NH, Ports TA, Snider AR, Schiller NB, Carlsson E, Heilbron DC. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons. Circulation 1980;62:548-57. 7. Gutman J, Wang YS, Wahr D, Schiller NB. Normal left atria1 function determined by two-dimensional echocardiography. Am J Cardiol 1983;51:336-40. 8. Hiraishi S, Di Sessa TG, Jarmakani JM, Nakanishi T, IsabelJones J, Frieman WF. Two-dimensional echocardiographic assessment of left atria1 size in children. Am J Cardiol 1983; 52:1249-57. 9. Wahr D, NB. Left ventricular volumes . . Yin . . SW, . .Schiller determined by two-dtmensional echocardiography in a normal adult population. J Am Co11 Cardiol 1983;1:863-8. 10. Himelman RB, Cassidy M, Landzberg J, Schiller NB. Reproducibility of quantitaive two-dimensional echocardiography.
AM HEART J 1988;115:425-31
Effects of aging on left ventricular function
structure
and
To better characterize the cardiac structural and functional changes that are associated with aging, Doppler-echocardiography was performed on 23 young (mean age, 25 years) and 30 old (mean age, 70 years) healthy normotensive subjects. Left ventricular cavity dimensions and wall thickness were determined and left ventricular mass index was calculated from M-mode echocardiograms. Stroke volume was calculated from Doppler-measured aortic flow. Diastolic filling was evaluated by pulsed Doppler echocardidgraphy of mitral inflow. Posterior wall thickness (1.0 vs 0.8 cm, p < 0.05) and relative wall thickness (0.42 vs 0.35, p < -05) were significantly greater in the elderly subjects compared with the younger subjects. Left ventricular mass index increased on average 0.25 gm/m2/yr but was not significantly increased in the elderly compared with the younger subjects (89 vs 77 gm/m2). Shortening fraction and stroke volume did not differ between the two groups. Diastolic filling was dramatically altered with aging, and the elderly subjects demonstrated a doubling of percent atrial contribution (37% vs 19%, p < 0.0001) and halving of peak early-to-peak atrial velocity ratio (0.85 vs 1.77, p < .Ol). AM HEART
J 1991;121:871.)
Anthony C. Pearson, MD, Chalapathirao Arthur J. Labovitz, MD. St. Louis, MO.
V. Gudipati,
From the Department of Internal Medicine, Division of Cardiology, St. Louis University Medical Center, St. Louis, Mu. Received for publication July 16, 1990; accepted Sept. 1, 1990. Reprint requests: Anthony C. Pearson, MD, Division of Cardiology, The Ohio State University, 657 Means Hall, 1654 Upham Dr., Columbus, OH 43210. Q/1/26478
MD, and
The elderly represent the most rapidly growing group in the nation. Over 5500 individuals reach their sixty-fifth birthday each day. As the number and the proportion of elderly individuals in the population increases, knowledge of normal morphologic and physiologic changes that accompany aging becomes 871
872
Pearson, Gudipati,
and Labovitz
Table
I. Clinical characteristics Elderly
n Age (yr)
Sex(F/M) BSA (m2) Heart rate (beats/min)
30 70 * 5 16114 1.8 * 0.2 67 ? 8
American
Young 23 25 + 5 1617 1.9 * 0.2 72 ?I lO*
BSA, Body surface area. *p < 0.05.
increasingly important. Although the diastolic functional changes that are associated with aging have been well characterized, the effect of aging on normal systolic function and left ventricular mass is less clear. Therefore we used Doppler echocardiography to identify the morphologic and functional changes that are related to aging in a group of normotensive, community-dwelling, elderly volunteers. METHODS Study group.
The study population consisted of two groups of normotensive subjects (1) healthy, elderly individuals age65 or older and (2) young individuals age35 or younger. All the subjectswere volunteers who were free of symptoms and had no evidence of coronary artery disease, congestive heart failure, hypertension, or valvular heart diseaseby history, physical examination, and two-dimensionaland Doppler echocardiographicexaminations. None of them were taking any medications.All the subjectswere community-dwelling and physically active. Ultrasound studies. All subjects underwent complete M-mode, two dimensional,and Doppler echocardiography with commercially available ultrasound units with transducer frequencies of 2.0 to 3.5 mHz. Standard views were used from parasternal and apical windows. M-mode and Doppler echocardiogramswererecorded on hard copy at 50 to 100mm/set under two-dimensional guidance.According to the recommendations of the American Society of Echocardiography,l the thickness of the posterior wall and interventricular septum, the left ventricular end-diastolic and end-systolic dimensions,and the left atria1 and aortic sizes were measuredfrom M-mode echocardiograms.All appropriate measurementswere indexed to the body surface area, and thus left ventricular end-diastolic and endsystolic dimension indices, and left atria1 index were obtained. The left ventricular mass(LVM) wascalculated with an anatomically validated formula2 and with left ventricular end-diastolic dimension (LVEDD) and septal (VS) and posterior wall thickness (PW). LVM = 0.8 (1.04 {LVEDD + PW + VS)3 - (LVEDD)3}) + 0.6 gm. Left ventricular masswasdivided by the body surface area to calculate left ventricular mass index in grams/per square meter. Relative wall thicknesswasdetermined as:posterior wall thickness x2/LVEDD. The interventricular septum and posterior wall during the cardiac cycle were digitized with the use of custom-madesoftware, and the maximum
March 1991 Heart Journal
rate of changein left ventricular internal diameter during diastole (maximum DD/DT) and during systole (velocity of circumferential fiber shortening) were measured, For mitral inflow recordings,Doppler examinationswere performed with the transducer held at the cardiac apex to visualize the apical four-chamber view. In pulsedmode,the Doppler beamwasaligned parallel to the presumedmitral inflow, and the samplevolume wasplacedjust on the ventricular side of the mitral anulus. Velocity recordings of 5 consecutivebeats were chosenfor analysis and the results were averaged. Analysis. Measurementswere made on a digitizing pad connected to microcomputer and custom-made software wasused. The time from the onset of mitral inflow to the end of mitral flow wasthe diastolic filling period. The peak early and the peak atria1 velocities, integrals, and their ratios were measured.The one-third filling fraction was determined by dividing the areaunder the curve at one third of diastole by the total area under the curve. The percent atria1 contribution to left ventricular filling was determined by dividing the area under the portion of the mitral inflow tracing that occurred during atria1 systoleby the total area under the curve. Left ventricular outflow velocities were obtained from the apical five-chamber view. In the pulsed mode, the Doppler beam was aligned parallel to the presumed left ventricular outflow, and the samplevolume wasplacedjust on the ventricular sideof the aortic valve. Velocity recordingsof 5 consecutivebeatswere chosenfor analysisand the results were averaged.From the hard copy recordingswith custom-madesoftware, the peak velocity, the mean velocity, the acceleration time (time to reach the peak velocity), mean acceleration index (the peak velocity/acceleration time), and flow velocity integrals were measured.Cardiac output wascalculated by multiplying the flow velocity integral times the heart rate and the cross-sectionalarea of the left ventricular outflow tract. Statistics. All results were expressed as mean it SD. Significance wascomputed with Student’s two-tailed, unpaired t test. A p value
