Assessment of left ventricular diastolic filling by two-dimensional echocardiography

Although two-dimensional echocardiography has provided accurate measurements of left ventricular ejection fraction, the technique has been limited in the evaluation of diastolic function. First half-filling fraction, representing the difference between mid-diastolic and end-systolic volumes divided by stroke volume, is a recently introduced index of diastolic function. We developed a method for determining half-filling fraction by two-dimensional echocardiography with the use of the average of left ventricular internal diameters measured at the base, middle, and apical third of the ventricular cavity in multiple longitudinal planes. In 27 patients with a wide range of ventricular function, we compared angiographic measurements of half-filling fraction to results obtained by two-dimensional echocardiography. Half-filling fraction measured angiographically averaged (mean +/- SD) 0.58 +/- 0.15 (range 0.26 to 0.77) and measured by two-dimensional echocardiography averaged 0.58 +/- 0.15 (range 0.35 to 0.90). A significant correlation was found between angiographic and echocardiographic half-filling fractions (r = 0.84, SEE = 0.08). Results were similar in the presence or absence of segmental wall motion abnormalities. All seven patients with half-filling fractions below 0.50 by echocardiography had depressed half-filling fractions by angiography; three of these patients had ejection fractions of greater than or equal to 0.55. Thus half-filling fraction can be derived with two-dimensional echocardiography providing a noninvasive assessment of diastolic function.