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Echocardiographic assessment of abnormal left ventricular relaxation in man
Insights
Mitral valve opening timing relative to left ventricular wall motion is normal in early diastole, even with coronary artery disease. Abnormalities arise with impaired left ventricular contraction, affecting early diastolic function.
Area of Science:
- Cardiology
- Biomedical Engineering
- Physiology
Background:
- Early diastolic function is crucial for cardiac health.
- Understanding the interplay between mitral valve dynamics and left ventricular wall motion is key to diagnosing diastolic dysfunction.
Purpose of the Study:
- To investigate the temporal relationship between mitral valve opening and left ventricular wall movement in early diastole.
- To assess how coronary artery disease and left ventricular contraction abnormalities affect these timings.
Main Methods:
- Echocardiograms and cineangiograms of 64 patients were digitized.
- First derivatives were computed to analyze time relations between mitral valve and left ventricular wall motion.
- Patients were categorized based on coronary arteriograms and left ventricular angiograms.
Main Results:
- Normal time relations were observed in patients with normal coronary arteries and in those with obstructive coronary artery disease.
- These relations were disrupted in patients with segmental left ventricular contraction abnormalities.
- The degree of disruption correlated with the severity of left ventricular dysfunction.
Conclusions:
- Early diastolic timing between mitral valve opening and left ventricular wall motion is preserved in obstructive coronary artery disease.
- Segmental left ventricular contraction abnormalities significantly alter early diastolic mechanics.
- These findings suggest abnormal left ventricular cavity shape changes during isovolumic relaxation in diseased states.
Abstract:
In 64 patients requiring cardiac catheterization for chest pain, echocardiograms showing anterior mitral leaflet and left ventricular cavity simultaneously were recorded. These were digitized and their first derivatives computed in order to study time relations between mitral valve and left ventricular wall movement in early distole. In 10 patients with normal left ventricular angiograms and coronary arteriograms, mitral valve opening began 1-1 +/- 9-3 ms (mean +/- SD) before the onset of outward wall movement, and reached peak opening velocity 2-0 +/- 13 ms after maximum rate of change of dimension. Virtually identical time relations were seen in 15 patients with normal left ventricular angiograms but with obstructive coronary artery disease (3-6 +/- 9-3 ms and 0-7 +/- 7-3 ms, respectively). These close relations were lost in patients with segmental abnormalities of contraction on left ventricular angiogram. In 19 such patients with normal septal motion, outward wall movement began 53 +/- 31 ms before the onset of anterior movement of the mitral valve leaflet, and this isovolumic wall movement accounted for 31 per cent of the total diastolic excursion. In 9 patients with reversed septal movement, these abnormalities were greater, 92 +/- 39 ms and 33 per cent, respectively, while in 11 patients with diffuse left ventricular involvement they were small, 5-5 +/- 13 ms and 3 per cent. Frame-by-frame digitization of cineangiograms was used to confirm these findings which appear to reflect an abnormal change in left ventricular cavity shape during isovolumic relaxation.
