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Diastolic function of the nonfilling human left ventricle
W J Paulus1, P J Vantrimpont, M F Rousseau
1Cardiovascular Center, O.L.V. Ziekenhuis, Aalst, Belgium.
Journal of the American College of Cardiology
|December 1, 1992
Summary
This study investigated early-diastolic left ventricular suction in humans during mitral stenosis treatment. Findings suggest reduced suction due to myocardial and external forces, and balloon interference, rather than a negative pressure asymptote.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Interventional Cardiology
Background:
- Early diastolic suction effect observed in canine models.
- Mitral inflow impedance in dogs led to negative left ventricular pressure asymptote.
- This suggested an early diastolic suction mechanism.
Purpose of the Study:
- Investigate early-diastolic left ventricular suction in humans.
- Utilize pressure recordings during percutaneous mitral valvuloplasty (PMV).
- Assess suction during Inoue balloon inflation in mitral stenosis patients.
Main Methods:
- Obtained left ventricular pressure recordings using tip-micromanometers in 23 mitral stenosis patients.
- Performed percutaneous mitral valvuloplasty with Inoue balloon inflations.
- Analyzed nonfilling beats with long diastolic intervals for pressure decay and asymptote calculation.
Main Results:
- Left ventricular diastolic asymptote pressure averaged 2-3 mm Hg, significantly positive.
- Left ventricular end-diastolic volume was comparable to end-systolic volume.
- Time constant of pressure decay (T(asy)) was 37 ms, significantly different from best-fit asymptote (TBF).
Conclusions:
- Human hearts showed positive left ventricular asymptote pressure, not negative suction.
- Reduced internal/external myocardial forces and balloon interference likely explain lack of suction.
- T0 was a better measure of T(asy) than TBF in this context.