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Diastolic flow in the left ventricular outflow tract - A normal physiological and underappreciated echocardiographic

Brian Cowie1,2, Ben Costello1, Leah Wright1

  • 1Sports Cardiology Laboratory Baker Heart and Diabetes Institute 75 Commerical Road Melbourne Victoria 3004 Australia.

Australasian Journal of Ultrasound in Medicine
|August 18, 2022
PubMed

Insights

Diastolic waveforms in the left ventricular outflow tract (LVOT) are common in athletes and non-athletes. These waves are a normal finding, more prominent in athletes, and linked to factors like age and heart rate.

Area of Science:

  • Cardiology
  • Echocardiography
  • Physiology

Background:

  • Diastolic waveforms in the left ventricular outflow tract (LVOT) are frequently observed via Doppler echocardiography.
  • The precise incidence and underlying mechanisms of these waveforms remain incompletely understood.

Purpose of the Study:

  • To determine the incidence of LVOT diastolic waveforms in adult athletes and non-athletes.
  • To investigate echocardiographic associations related to these LVOT diastolic waveforms.

Main Methods:

  • A retrospective observational study involving 186 adult patients (athletes and non-athletes) without known cardiac disease.
  • Comprehensive transthoracic echocardiography was performed at a research institute.

Main Results:

  • LVOT early to mid-diastolic waveforms were detected in 100% of athletes and 95% of non-athletes.
  • The LVOT diastolic velocity time integral was significantly larger in athletes (8.3 cm) compared to non-athletes (5.1 cm).
  • Key predictors included younger age, slower heart rate, larger stroke volume, higher mitral E, and elevated E/e'.

Conclusions:

  • LVOT early diastolic waves represent a normal physiological finding, associated with a flow vortex redirecting mitral inflow.
  • These diastolic LVOT waves are nearly universal, more pronounced in young athletes, and correlate with younger age, slower heart rate, greater stroke volume, and enhanced diastolic function.
Abstract

Keywords:
diastoleechocardiographyhaemodynamicsstroke volumetransthoracic

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