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The left ventricular intracavitary vortex during the isovolumic contraction period as detected by vector flow mapping
Haibin Zhang1, Jun Zhang, Xiaoxing Zhu
1Department of Ultrasound, PLA 210th Hospital, Dalian, China.
Insights
Vector flow mapping reveals a left ventricular (LV) vortex during isovolumic contraction (IVC). Impaired cardiac function is linked to a less sustained vortex, impacting blood ejection.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Hemodynamics
Background:
- Understanding intracavitary blood flow dynamics is crucial for diagnosing cardiac dysfunction.
- The isovolumic contraction (IVC) period is a critical phase of the cardiac cycle.
- Vector flow mapping (VFM) offers advanced visualization of blood flow patterns.
Purpose of the Study:
- To characterize left ventricular (LV) intracavitary flow during the IVC period in humans.
- To investigate the role of LV vortex formation during IVC using VFM.
Main Methods:
- Color flow Doppler imaging was employed from the apical long-axis view.
- Data were acquired in 61 patients with heart failure and 58 healthy volunteers.
- Offline analysis utilized vector flow mapping (VFM) for Doppler flow data during IVC.
Main Results:
- A significant LV vortex formed from inflow to outflow during IVC.
- In healthy subjects, vortex area was sustained, while volume decreased during IVC.
- Patients with heart failure exhibited more severe decreases in vortex area and volume during IVC.
- LV ejection fraction, QRS width, and LV end-systolic diameter predicted vortex changes.
Conclusions:
- The LV vortex during IVC aids in early systolic blood ejection.
- An unsustained or diminished vortex during IVC is associated with impaired cardiac function.
Aims:
The purpose of this study was to characterize left ventricular (LV) intracavitary flow during the isovolumic contraction (IVC) period in humans using vector flow mapping.
Methods:
Color flow Doppler imaging was performed from the apical long-axis view in 61 patients with heart failure and 58 healthy volunteers. Doppler flow data obtained during IVC were analyzed offline with vector flow mapping.
Results:
A large vortex was formed from the LV inflow toward the outflow during IVC. In normal subjects, the area of the vortex was sustained, but the flow volume decreased significantly during IVC (P < 0.001). A significant apex-to-base flow velocity gradient was shown along the outflow axis on aortic valve opening. However, both the area and flow volume of the vortex decreased more severely during IVC in the patients (P < 0.001). The apex-to-base flow velocity gradient along the outflow axis disappeared and a reversed velocity gradient was observed at the basal-mid level on aortic valve opening. In multivariate models, a decreased LV ejection fraction was the only independent predictor of the percentage decrease in area of the vortex during the IVC (P < 0.001), and a larger QRS width (P = 0.028) and LV end-systolic long diameter (P = 0.002) were independent predictors of the percentage decrease in flow volume of the vortex.
Conclusions:
The vortex across the LV inflow-outflow region during IVC facilitates the ejection of blood during early systole, and an unsustained vortex may be associated with impaired cardiac function.
