Pattern of left ventricular diastolic filling in chronic aortic regurgitation: a gated blood pool assessment
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Patients with chronic aortic regurgitation (AR) exhibit abnormal left ventricular diastolic filling patterns, characterized by reduced peak filling rate (PFR) and mean filling rate (MFR). This study quantifies these changes in AR patients compared to healthy individuals.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Chronic aortic regurgitation (AR) significantly impacts left ventricular (LV) function.
- Detailed understanding of LV diastolic filling patterns in moderate to severe AR is limited.
Purpose of the Study:
- To investigate and characterize the pattern of left ventricular diastolic filling in patients with moderate to severe chronic aortic regurgitation.
- To compare diastolic filling parameters between AR patients and normal subjects.
Main Methods:
- Evaluated left ventricular diastolic filling curves using gated blood pool scans.
- Assessed parameters including peak filling rate (PFR), mean filling rate (MFR), and peak ejection rate (PER) in 29 AR patients and 24 normal subjects.
- Calculated ratios PFR/MFR and PFR/PER, and the rapid filling period to diastolic time ratio.
Main Results:
- Patients with AR demonstrated significantly lower PFR (2.24 vs 3.09 EDV/s) and MFR (1.31 vs 1.63 EDV/s) compared to normal subjects.
- Reduced PER and altered ratios (PFR/MFR, PFR/PER) were observed in the AR group.
- The rapid filling period to diastolic time ratio was longer in AR patients, indicating a more linear filling pattern.
Conclusions:
- Moderate to severe chronic AR is associated with an abnormal LV diastolic filling pattern.
- This pattern is characterized by reduced filling rates and a prolonged rapid filling phase, even in asymptomatic patients.
- Findings highlight impaired diastolic function as a key consequence of chronic AR.
Abstract:
Limited information exists regarding the pattern of left ventricular diastolic filling in moderate to severe chronic aortic regurgitation (AR). The left ventricular diastolic filling curve derived from gated blood pool scans was evaluated in 24 normal subjects and 29 patients with AR. The peak filling rate (PFR), mean filling rate (MFR), peak ejection rate (PER), PFR/MFR, PFR/PER, and the time of the rapid filling period divided by the diastolic time were determined. PFR, MFR and PER were calculated as end-diastolic volumes per second (EDV/s). PFR was lower in the AR group than in the normal subjects (2.24 +/- 0.70 vs 3.09 +/- 0.71 EDV/s, p less than 0.001). Similarly, MFR was lower in the AR group (1.31 +/- 0.40 vs 1.63 +/- 0.29 EDV/s, p less than 0.01). PER was also reduced in the AR group. Both PFR/MFR and PFR/PER were reduced, while the ratio of rapid filling period to diastolic time was longer in the AR group than in normal subjects. Clinical evidence of congestive heart failure occurred in 8 patients in the AR group. Diastolic filling variables were not significantly different from the asymptomatic subgroup of patients with AR, but were abnormal when compared with those of normal subjects. In patients with AR, an abnormal pattern of diastolic filling was noted, consisting of a reduced PFR, MFR and PFR/ with a more linear pattern of filling (reduced PFR/MFR) during a longer rapid filling period.