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Mechanisms of retarded apical filling in acute ischemic left ventricular failure

K Steine1, M Stugaard, O A Smiseth

  • 1Institute for Surgical Research, Rikshospitalet, Oslo, Norway.

Circulation
|April 20, 1999
PubMed
Abstract

Insights

Retardation of apical filling in the left ventricle (LV) during ischemia is linked to reduced mitral-to-apical pressure. This indicates slower LV relaxation and a shift in filling patterns.

Area of Science:

  • Cardiovascular Physiology
  • Echocardiography
  • Heart Failure Research

Background:

  • Assessing left ventricular (LV) apical filling using Doppler echocardiography.
  • Investigating the relationship between apical filling and intraventricular pressure gradients.

Purpose of the Study:

  • To test if slowed apical filling in diseased LV indicates reduced mitral-to-apical pressure gradient.
  • To explore the physiological mechanisms behind impaired LV filling during ischemia.

Main Methods:

  • Utilized color M-mode Doppler echocardiography and micromanometers in 9 open-chest dogs.
  • Induced acute ischemic LV failure via coronary microembolization.
  • Measured time delay (TD) of flow propagation and LV pressure decay (tau).

Main Results:

  • Ischemia significantly increased LV end-diastolic pressure and decreased ejection fraction.
  • Mitral-to-apical pressure gradient (DeltaPLVmitral-apex) decreased, and TD increased significantly.
  • TD correlated strongly with reduced pressure gradient and increased tau, indicating slowed relaxation.

Conclusions:

  • Decreased mitral-to-apical driving pressure causes slowed apical filling in ischemic LV failure, reflecting impaired relaxation.
  • Altered flow propagation shifts from column motion to convection-dominated filling during ischemia.

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