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Importance of left ventricular systolic function in the assessment of left ventricular diastolic function with
Y Himura1, T Kumada, M Kambayashi
1Department of Internal Medicine, Faculty of Medicine, Kyoto University, Japan.
Insights
Left ventricular systolic function significantly impacts Doppler transmitral flow patterns. Impaired relaxation and increased stiffness in heart disease patients alter flow dynamics, correlating with specific echocardiographic variables.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Left ventricular systolic function is crucial for normal cardiac hemodynamics.
- Doppler echocardiography is a key non-invasive tool for assessing cardiac function.
- Understanding the relationship between systolic function and transmitral flow is vital for diagnosing heart disease.
Purpose of the Study:
- To investigate how left ventricular systolic function influences Doppler transmitral flow velocity patterns.
- To correlate Doppler echocardiographic variables with hemodynamic indexes in patients with heart disease.
Main Methods:
- Doppler echocardiography and cardiac catheterization were performed on control subjects and patients.
- Left ventricular pressure changes and myocardial stiffness were calculated.
- Patients were categorized into two groups based on ejection fraction.
Main Results:
- Patients with reduced ejection fraction showed impaired relaxation, increased preload, pulmonary capillary pressure, and myocardial stiffness.
- A correlation was found between impaired relaxation and deceleration half-time in one patient group.
- Myocardial stiffness strongly correlated with peak atrial filling velocity and the ratio of peak atrial to peak rapid filling velocity in another group.
Conclusions:
- Left ventricular systolic dysfunction significantly alters transmitral flow patterns.
- Specific Doppler variables reflect underlying hemodynamic changes and myocardial stiffness.
- Echocardiographic assessment of transmitral flow provides insights into left ventricular systolic function and diastolic properties.
Abstract:
To study the effect of left ventricular systolic function on the Doppler transmitral flow velocity pattern, Doppler echocardiographic variables were correlated with hemodynamic indexes in 11 control subjects and 58 patients with heart disease. All underwent cardiac catheterization performed with use of a Millar micromanometer. The time constant of left ventricular isovolumetric pressure decrease and left ventricular end-diastolic myocardial stiffness was calculated. The 58 patients were classified into two groups according to ejection fraction: group I (n = 30; ejection fraction greater than 55%) and group II (n = 28; ejection fraction less than 50%). Compared with the control subjects, patients in group I had impairment only of left ventricular relaxation (time constant 47 +/- 9 vs. 38 +/- 3 ms; p less than 0.01), whereas patients in group II had, in addition to impaired left ventricular relaxation (time constant 52 +/- 11 vs. 38 +/- 3 ms; p less than 0.01), increased preload, increased pulmonary capillary pressure (12 +/- 8 vs. 5 +/- 3 mm Hg; p less than 0.01) and increased myocardial stiffness (2,018 +/- 980 vs. 1,050 +/- 218 g/cm2; p less than 0.01). In group I, there was a significant partial correlation coefficient between the time constant and deceleration half-time (r = 0.54). In group II, a strong correlation existed between myocardial stiffness and peak atrial filling velocity (r = -0.71) and between myocardial stiffness and the ratio of peak atrial to peak rapid filling velocity (r = -0.71).(ABSTRACT TRUNCATED AT 250 WORDS)