Comparison of diastolic filling models and their fit to transmitral Doppler contours

Anatomic/physiologic and kinematic mathematical models of diastolic filling which employ (lumped) parameters of diastolic function have been used to predict or characterize transmitral flow. The ability to determine model parameters from clinical transmitral flow, the Doppler velocity profile (DVP), is equivalent to solving the "inverse problem" of diastole. Systematic model-to-model and model-to-data comparison has never been carried out, in part due to the requirement that DVPs be digitized by hand. We developed, tested and verified a computerized method of DVP acquisition and reproduction, and carried out numerical determination of model-to-model and model-to-data goodness-of-fit. The transmitral flow velocity of two anatomic/physiologic models and one kinematic model were compared. Each model's ability to fit computer-acquired and reproduced transmitral DVPs was assessed. Results indicate that transmitral flow velocities generated by the three models are 'graphically indistinguishable and are able to fit the E-wave of clinical DVPs with comparable mean-square errors. Nonunique invertibility of the anatomic/physiologic models was verified, i.e., multiple sets of model parameters could be found that fit a single DVP with comparable mean-square error. The kinematic formulation permitted automated, unique, model-parameter determination, solving the "inverse problem" for the Doppler E-wave. We conclude that automated, quantitative characterization of clinical Doppler E-wave contours using this method is feasible. The relation of kinematic parameters to physiologic variables is a subject of current investigation.