Doppler Echocardiographic Investigations

  • H. Acquatella

Abstract

Restrictive cardiomyopathy is characterised by abnormal filling of the ventricles, consisting of a disproportionate rise in ventricular pressure in early diastole for a given increase in volume. Pathological changes in endomyocardial disease (with or without hypereosinophilia) affect ventricular compliance by unknown mechanisms leading to a restrictive pattern of filling. This haemodynamic profile is usually documented by cardiac catheterisation but may be recognised non-invasively by pulsed Doppler echocardiography of mitral and tricuspid inflow velocities. This profile consists of a short isovolumic relaxation time, increased peak early inflow velocity, increased early deceleration time, decreased late atrial inflow peak velocity, and an increased ratio of early/late peak flow velocities. Vena cava and pulmonary venous blood flow velocities disclose predominant filling during early diastole and severe blunting of normal ante-grade systolic flow. This restrictive profile is also presented by other endocardial or myocardial conditions. In pericardial constriction similar findings exist, but contrary to restriction these are greatly influenced by respiration. Endomyocardial biopsy is the diagnostic technique of choice during the early stages of endomyocardial disease. Two-dimensional echocardiography has increased the detection of endomyocardial fibrosis by showing a peculiar distribution of abnormal endocardium, obliteration of the ventricular apex, and the combination of near-normal-sized ventricles with dilated atria.

Keywords

Leukemia Respiration Expense Cardiomyopathy Cardiol 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    WHO/ISFC (1980) Task Force report on the definition and classification of cardiomyopathies. Br Heart J 44: 672CrossRefGoogle Scholar
  2. 2.
    Davies JNP, Ball JD (1955) The pathology of endomyocardial fibrosis in Uganda. Br Heart J 17: 337–359PubMedCrossRefGoogle Scholar
  3. 3.
    Shaper AG, Hutt MSR, Coles RM (1968) Necropsy study of endomyocardial fibrosis and rheumatic heart disease in Uganda 1950–65. Br Heart J 30: 391–401PubMedCrossRefGoogle Scholar
  4. 4.
    Acquatella H, Schiller NB, Puigbo JJ, Gomez-Mancebo JR, Suarez C, Acquatella G (1983) Value of two-dimensional echocardiography in endomyocardial disease with and without eosinophilia: a clinical and pathological study. Circulation 62: 1219–1226CrossRefGoogle Scholar
  5. 5.
    Andrade ZA, Guimaraes AC (1964) Endomyocardial fibrosis in Bahia, Brazil. Br Heart J 26: 813–820CrossRefGoogle Scholar
  6. 6.
    Vijayaraghavan G, Davies J, Sadanandan S, Spry CJ, Gibson DH, Goodwin JF (1983) Echocardiographic features of tropical endomyocardial disease in South India. Br Heart J 50: 450–459PubMedCrossRefGoogle Scholar
  7. 7.
    Löffler W (1936) Endocarditis parietalis fibroplastica mit Bluteosinophilie: ein eigenartiges Krankheitsbild. Schweiz Med Wochenschr 18: 817–820Google Scholar
  8. 8.
    Roberts WC, Buja LM, Ferrans VJ (1970) Löffler’s fibroplastic parietal endocarditis, eosinophilic leukemia, and Davies endomyocardial fibrosis: the same disease at different stages. Pathol Microbiol 35: 90–95Google Scholar
  9. 9.
    Chusid MJ, Dale DC, West BC, Wolff SM (1975) The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine (Baltimore) 54: 1–27CrossRefGoogle Scholar
  10. 10.
    Goodwin JF (1983) Endomyocardial disease:clinical features. Postgrad Med J 59: 154–156PubMedCrossRefGoogle Scholar
  11. 11.
    Brockington IF, Olsen EGJ (1973) Löfller’s endocarditis and Davies endomyocardial fibrosis. Am Heart J 85: 308–322CrossRefGoogle Scholar
  12. 12.
    Roberts WC, Buja LM, Ferrans VJ (1970) Löfffer’s fibroplastic parietal endocarditis, eosinophilic leukemia, and Davies’ endomyocardial fibrosis: the same disease at different stages? Pathol Microbiol 35: 90–95Google Scholar
  13. 13.
    Roberts WC, Liegler DG, Carbone PP (1969) Endomyocardial disease and eosinophilia: a clinical and pathologic spectrum. Am J Med 46: 28–42.PubMedCrossRefGoogle Scholar
  14. 14.
    Davies JNP (1948) Endomyocardial fibrosis in Africans. East Afr Med J 25: 10–14Google Scholar
  15. 15.
    Kartha CC, Sandhyamani S (1985) An autopsy study of tropical endomyocardial fibrosis in Kerala. Indian J Med Res 82: 439–446PubMedGoogle Scholar
  16. 16.
    Bell JA, Jenkins BS, Webb-Peploe MM (1976) Clinical, haemodynamic, and angiographic findings in Löftler’s eosinophillic endocarditis. Br Heart J 38: 541–548PubMedCrossRefGoogle Scholar
  17. 17.
    Chew CYC, Ziady GM, Raphael MJ, Nellen M, Oackley CM 1 (1977) Primary restrictive cardiomyopathy: non-tropical endomyocardial fibrosis and hypereosinophilic heart disease. Br Heart J 39: 399–413PubMedCrossRefGoogle Scholar
  18. 18.
    Hess OM, Turina M, Senning A, Goebel NH, Scholer Y, Krayenbiihl HP (1978) Pre-and postoperative findings in patients with endomyodardial fibrosis. Br Heart J 40: 406–415PubMedCrossRefGoogle Scholar
  19. 19.
    Appleton CP, Hatle LV, Popp RL (1988) Demonstration of restrictive ventricular physiology by Doppler echocardiography. J Am Coll Cardiol 11: 757–768PubMedCrossRefGoogle Scholar
  20. 20.
    Spry CJF (1987) Eosinophils and endomyocardial fibrosis: a review of clinical and experimental studies, 1980–86. In: Kawal C, Abelmann WM (eds) Pathogenesis of myocarditis and cardiomyopathy: recent experimental and clinical studies. University of Tokyo Press, Tokyo, pp 293–310Google Scholar
  21. 21.
    Olsen EGJ, Spry CJF (1979) The pathogenesis of Löffler’s endomyocardial disease, and its relationship to endomyocardial fibrosis. In: Yu PN, Goodwin JF (eds) Progress in cardiology, vol 8. Lea and Febiger, Philadelphia, pp 281–303Google Scholar
  22. 22.
    Olsen EGJ, Spry CJF (1985) Relation between eosinophilia and endomyocardial disease. Prog Cardiovasc Dis 27: 241–254PubMedCrossRefGoogle Scholar
  23. 23.
    Benotti JR, Grossman W, Cohn PF (1980) Clinical profile of restrictive cardiomyopathy. Circulation 61: 1206–1212PubMedGoogle Scholar
  24. 24.
    Goodwin JF (1985) Cardiomyopathies and specific heart muscle diseases: definition, terminology and classification. In: Goodwin JF (ed) Heart muscle disease. MTP Press, Lancaster, pp 1–5Google Scholar
  25. 25.
    Hatle LK, Appleton CP, Popp RL (1989) Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation 79: 357–370PubMedCrossRefGoogle Scholar
  26. 26.
    Nishimura RA, Abel MD, Hatle LK, Tajik AJ (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. II. Clinical studies. Mayo Clin Proc 64: 181–204Google Scholar
  27. 27.
    Abelmann WH, Lore11 BH (1989) The challenge of cardiomyopathy. J Am Coll Cardiol 13: 1219–1239PubMedCrossRefGoogle Scholar
  28. 28.
    Child JS, Perloff JK (1988) The restrictive cardiomyopathies. Cardiol Clin 6: 289–316PubMedGoogle Scholar
  29. 29.
    Davies J, Gibson DG, Foale R, Herr K, Spry CJF, Oakley CM, Goodwin JF, (1982) Echocardiographic features of eosinophilic endomyocardial disease. Br Heart J 48: 434–440PubMedCrossRefGoogle Scholar
  30. 30.
    Case Records of the Massachusets General Hospital (1980) Case no. 18. N Engl J Med 302: 1077–1083Google Scholar
  31. 30a.
    Andy JJ, Bishara FF, Soyinka OO (1981) Relation of severe eosinophilia and microfilariasis to chronic African endomyocardial fibrosis. Br Heart J 45: 672–680PubMedCrossRefGoogle Scholar
  32. 31.
    Dienot B, Ekra A, Bertrand E (1979) L’echocardiographie dans 23 cas de fibroses endomyocardiques constrictives droites ou bilaterales. Arch Mal Coeur 72: 1101–1107PubMedGoogle Scholar
  33. 32.
    Take M, Sekiguchi M, Hiroe M, Hirosawa K, Mizoguchi H, Kijima M, Shirai T, Ishide T, Okubo S (1985) Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease. In: Sekiguchi M, Olsen EGJ, Goodwin JF (eds) Myocarditis and related disorders. Springer, Berlin Heidelberg New York, pp 243–249Google Scholar
  34. 33.
    DePace NL, Nestico PF, Morganroth J, Ross J, Fox R, Kotler MN, Mintz GS, Vassallo R (1983) Dilated cardiomyopathy in the idiopathic hypereosinophilic syndrome. Am J Cardiol 52: 1359–1360PubMedCrossRefGoogle Scholar
  35. 34.
    Acquatella H (1989) Echocardiographic overview of Chagas’ disease and endomyocardial fibrosis: diagnostic implications for non-tropical countries. Echocardiography 6: 137–157CrossRefGoogle Scholar
  36. 35.
    Hall SW, Theologides A, From AHL, Gobel FL, Fortuny IE, Lawrence CJ, Edwards JE (1977) Hypereosinophilic syndrome with biventricular involvement. Circulation 55: 217–222PubMedGoogle Scholar
  37. 36.
    George BO, Gaba FE, Talabi AI (1982) M-mode echocardiographic features of endomyocardial fibrosis. Br Heart J 48: 222–228PubMedCrossRefGoogle Scholar
  38. 37.
    Richardson PJ, Daly K, Gishen P (1984) Hemodynamic findings in biopsy proven acute myocarditis. In: Bolte HD (ed) Viral heart disease. Springer, Berlin Heidelberg New York, pp 165–172Google Scholar
  39. 39.
    Pernod J, Gerbaux A, Vernin P, Terdjman M, Lelguen C, Droniou J (1980) Apport de l’echocardiographie dans le diagnostic des fibroses endomyocardiques. Arch Mal Coeur 73: 139–146PubMedGoogle Scholar
  40. 40.
    Candell-Riera J, Permanyer-Miralda G, Soler-Soler J (1982) Echocardiogrphic findings in endomyocardial fibrosis. Chest 82: 88–90PubMedCrossRefGoogle Scholar
  41. 41.
    Gottdiener JS, Maron BJ, Schooley RT, Harley JB, Roberts WC, Fauci AS (1983) Two-dimensional echocardiographic assessment of the idiopathic hypereosinophilic syndrome: anatomical basis of mitral regurgitation and peripheral embolization. Circulation 67: 572–578Google Scholar
  42. 42.
    Puigbo JJ, Combellas I, Acquatella H, Marsiglia I, Tortoledo F, Casal H, Suarez JA (1983) Endomyocardial disease in South America: report on 23 cases in Venezuela. Postgrad Med J 59: 162–168PubMedCrossRefGoogle Scholar
  43. 43.
    Bletry O, Scheuble C, Cereze P, Masquet P, Priollet P, Balafrej M, Godeau P (1984) Cardiac manifestations of the hypereosinophilic syndrome: the value of 2-dimensional echography (12 cases). Arch Mal Coeur 77: 633–641PubMedGoogle Scholar
  44. 44.
    Fawsy ME, Ziady G, Halim M, Guindy R, Mercer EN, Feteih N (1985) Endomyocardial fibrosis: report of eight cases. J Am Coll Cardiol 5: 983–988CrossRefGoogle Scholar
  45. 45.
    Seward JB, Khandheria BK, Oh JK, Abel MD, Hughes RW Jr, Edwards WD, Nichols BA, Freeman WK, Tajik AJ (1988) Transesophageal echocardiography: technique, anatomic correlations, implementation, and clinical applications. Mayo Clin Proc 63: 649–680PubMedGoogle Scholar
  46. 46.
    Candell-Riera J, Garcia del Castillo H, Permanyer-Miralda G, Soler-Soler J (1978) Echocardiographic features of the interventricular septum in chronic constrictive pericarditis. Circulation 57: 1154–1158PubMedGoogle Scholar
  47. 47.
    Parrillo JE, Borer JS, Henry WL, Wolff SM, Fauci AS (1979) The cardiovascular manifestations of the hypereosinophilic syndrome: prospective study of 26 patients, with review of the literature. Am J Med 67: 572–582PubMedCrossRefGoogle Scholar
  48. 48.
    Brutsaert DL, Rademakers Fe, Sys SU, Gillebert TC, Housmans PR (1985) Analysis of relaxation in the evaluation of ventricular function of the heart. Prog Cardiovasc Dis 28: 143–163PubMedCrossRefGoogle Scholar
  49. 49.
    Nishimura RA, Housmans PR, Hatle LK, Tajik AJ (1989) Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. 1. Physiologic and pathophysiologic features. Mayo Clin Proc 64: 71–81Google Scholar
  50. 50.
    Harizi RC, Bianco JA, Alpert JS (1988) Diastolic function of the heart in clinical cardiology. Arch Intern Med 148: 99–109PubMedCrossRefGoogle Scholar
  51. 51.
    Rokey R, Kuo LC, Zoghbi WA, Limacher MC, Quinones MA (1985) Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation 71: 543–550PubMedCrossRefGoogle Scholar
  52. 52.
    Appleton CP, Hatle LV, Popp RL (1988) Relation of transmitral flow velocity patterns to left ventricular diastolic function: new insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 12: 426–440PubMedCrossRefGoogle Scholar
  53. 53.
    Keren G, Sherez J, Megidish R, Levitt B, Laniado S (1985) Pulmonary venous flow pattern: its relationship to cardiac dynamics. A pulsed Doppler echocardiographic study. Circulation 71: 1105–1112Google Scholar
  54. 54.
    Nishimura RA, Abel MD, Hatle LK, Tajik Al (1990) Relation of pulmonary vein to mitral flow velocities by transesophageal Doppler echocardiography: effect of different loading conditions. Circulation 81: 1488–1497PubMedCrossRefGoogle Scholar
  55. 55.
    Appleton CP, Hatle LK, Popp RL (1987) Superior vena cava and hepatic vein Doppler echocardiography in healthy adutls. J Am Coll Cardiol 10: 1032–1039PubMedCrossRefGoogle Scholar
  56. 56.
    Acquatella H, Rodriguez L, Puigbo JJ, Gomez-Mancebo JR, Casanova M, Combellas I, Giordano H (1990) Echocardiographic recognition and Doppler abnormalities in eosinophilic endomyocardial disease and endomyocardial fibrosis. In: Sekiguchi M, Olsen EGJ (eds) Cardiomyopathy and myocarditis. University of Tokyo Press, Tokyo, pp 35–47 (Cardiomyopathy update 3 ).Google Scholar
  57. 57.
    Acquatella H, Rodriguez-Salas LA, Gomez-Mancebo JR (1990) Doppler echocardiography in dilated and restrictive cardiomyopathies. Cardiol Clin 8: 349–367PubMedGoogle Scholar
  58. 58.
    Moraes CR, Buffolo E, Lima R, Victor E, Lira V, Escobar M, Rodrigues J, Saralva L, Andrade JC (1983) Surgical treatment of endomyocardial fibrosis. J Thorac Cardiovasc Surg 85: 738–745PubMedGoogle Scholar
  59. 59.
    Miyatake K, Kinoshita N, Nagata S, Beppu S, Park YD, Sakakibara H, Nimura Y (1980) Intracardiac flow pattern in mitral regurgitation studied with combined use of the ultrasonic pulsed Doppler technique and cross-sectional echocardiography. Am J Cardiol 45: 155–162PubMedCrossRefGoogle Scholar
  60. 60.
    Abbasi AS, Allen MW, DeCristofaro D, Ungar I (1980) Detection and estimation of the degree of mitral regurgitation by range-gated pulsed Doppler echocardiography. Circulation 61: 143–147PubMedGoogle Scholar
  61. 61.
    Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 75: 175–183PubMedCrossRefGoogle Scholar
  62. 62.
    Santamore WP, Bartlet R, Van Buren SJ, Dowd MK, Kutcher MA (1986) Ventricular coupling in constrictive pericarditis. Circulation 74: 597–602PubMedCrossRefGoogle Scholar
  63. 63.
    Falk RH, Plehn JF, Deering T, Schick EC, Boinay P, Rubinow A, Skinner M, Cohen AS (1987) Sensitivity and specificity of echocardiographic features of cardiac amyloidosis. Am J Cardiol 59: 418–422PubMedCrossRefGoogle Scholar
  64. 64.
    Siqueira Filho AG, Cunha CLP, Tajik AJ, Seward JB, Schattenberg TT, Giuliani ER (1981) M-mode and two-dimentional echographic features in cardiac amyloidosis. Circulation 63:188— 196Google Scholar
  65. 65.
    Cueto-Garcia L, Reeder GS, Kyle RA, Wood DL, Seward JB, Naessens J, Offord KP, Greipp PR, Edwards WD, Tajik AJ (1985) Echocardiographic findings in systemic amyloidosis: spectrum of cardiac involvement and relation to survival. J Am Coll Cardiol 6: 737–743PubMedCrossRefGoogle Scholar
  66. 66.
    Klein AL, Hatle LK, Burstow DJ, Seward JB, Kyle RA, Bailey KR, Luscher TF, Gertz MA, Tajik Al (1989) Doppler characterization of left ventricular diastolic function in cardiac amyloidosis. J Am Coll Cardiol 13: 1017–1026PubMedCrossRefGoogle Scholar
  67. 67.
    Siegel RJ, Shah PK, Fishbein MC (1984) Idiopathic restrictive cardiomyopathy. Circulation 70: 165–169PubMedCrossRefGoogle Scholar
  68. 68.
    Ortolani P, Rapezzi C, Binetti G, Baroni M, Mini A, Alampi G, Benati A, Branzi A, Magnani B (1989) Idiopathic restrictive cardiomyopathy: clinical, hemodynamic, histologic and prognostic profile. Cardiologia 34: 759–768PubMedGoogle Scholar
  69. 69.
    Valantine HA, Appleton CP, Hatle LK, Hunt SA, Billingham ME, Shumway NE, Stinson EB, Popp RL, (1989) A hemodynamic and Doppler echocardiographic study of ventricular function in long-term cardiac allograft recipients: etiology and prognosis of restrictive—constrictive physiology. Circulation 79: 66–75PubMedCrossRefGoogle Scholar
  70. 70.
    Gupta PN, Valiathan MS, Balakrishnan KG, Kartha CC, Ghosh MK (1989) Clinical course of endomyocardial fibrosis. Br Heart J 62: 450–454PubMedCrossRefGoogle Scholar
  71. 71.
    Skorton DJ, Collins SM (1988) Clinical potential of ultrasound tissue characterization in cardiomyopathies. J Am Soc Echocardiogr 1: 69–77PubMedGoogle Scholar
  72. 72.
    Loomis JF, Waggoner AD, Schechtman KB, Miller JG, Sobel BE, Perez JE (1990) Ultrasonic integrated backscatter two-dimentional imaging: evaluation of M-mode guided acquisition and immediate analysis in 55 consecutive patients. J Am Soc Echocardiogr 3: 255— 265Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1993

Authors and Affiliations

  • H. Acquatella

There are no affiliations available

Personalised recommendations