Diastolic Dysfunction on ECHO

[LukeL]

Echo showed mild to moderate LVH hypertrophy with evidence of Diastolic Dysfunction. All other values normal. Was wondering if anyone knew if tachycardia could cause a false positive of DD as my rate was around 120 at the time with many PVCs.

[Jack54]

There is no doubt in my mind that a high heart rate, or tachycardia, influenced your diastolic function during the echo. I have looked for about an hour and have not found a good source that definitively states that tachycardia can increase the finding of diastolic dysfunction, on an echocardiogram.

However you can find many references that speak of heart rate control in order to "increase" LV filling time in patients with Diastolic Dysfunction, which improves their symptoms. Heart rate control is one of the most important ways of treating DD.

Can you see on the echo results if your ventricular rate is the exact same as your atrial rate?

Probably not in your case, but during a stage of DD, atrial fibrillation starts to occur, because the left atrium has "compensated" for DD for so long. It becomes enlarged and out of sync with the LV (and the rest of the heart?). This compensation happens when the LV will not relax in the diastolic phase, which increases fill pressures substantially. The left atrium then "kicks' to try to overcome the high LV pressure and fill the LV. The Left Atrium can only kick for so long. This kick is the normal contraction of the left atrium, but increases with force in order to overcome the high fill pressures below it.

DD is identified on an echo due to the E to A fill ratios. E is the fill flow that immediately starts when the mitral valve opens and should always be more than A fill flow because, A is the flow produced by the contraction of the left atria.  So E/A should always be >1. If it is less than 1, then you have an E/A wave flow reversal, that is A becomes > E. Nothing really reverses in actual flow like it does in mitral regurgitation, MVR, or any other valve regurgitation.

DD is staged also. In the 2nd stage I believe, the E/A ratio goes back to normal or pseudo normalization from some type of LV compensation, probably when the Left Atrium loses it's "kick", and A flow decreases, which makes the ratio increase, or normalize.

I have Diastolic Dysfunction myself. I was diagnosed with this by the Cleveland Clinic during a cardiac cath 2 times. My LVED fill pressure increased from 24 mmhg to 27 mmhg between to cardiac caths, one in May and one in September at the CC. A cath is the proverbial gold standard for diagnosing DD, because of direct pressure measurements. DD is diagnosed when Left Ventricular End Diastolic Fill Pressure, LVEDP is >20mmhg in the US. In Europe I have read the diagnosis is made at >16mmhg.

Hope this helps,

Jack

[kenkeith]

For another perspective LV hypertrophy can be a cause of diastole dysfunction.  The etiology can/will reduce by crowding out the space available for filling.  Also hypertrophy stiffens the heart walls compromisintg cardiac output.

Do you have the M-mode values from your echo report?  Of interest is the heart walls and septal mesurements...and end diastole and end systole measurements.

Tachcardia will not give a false positive, but a very, very fast heart rate can prevent adequate time to fill during the diastole phase.

[kenkeith]

...the question may arise that a well-conditioned athlete has some LV hypertrophy with their exercise that causes a fast heart rate.  So why doesn't tachycardia (abnormal) produce the same results?  As I remember the difference is the morphology of heart tissues (muscle fibers).

[LukeL]

the reason why I ask this, is that for years I have had a very high resting heart rate (90-120) I also use to be very highly stressed and on edge most of the day, which produced mild hypertension (130-40/85-95)

I am now on meds for anxiety and heart rate and BP control (for anxiety) so I was just wondering if a fast heart rate and mild hypertension over the course of 5 years could produce mld LVH and DD