Clinical Application of Pulsed Doppler Tissue Imaging for Assessing Abnormal Left Ventricular Relaxation

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Abstract

Conventional assessment of left ventricular (LV) relaxation by calculating the time constant of LV pressure decay during the isovolumic diastole requires an invasive approach. Conversely, noninvasive parameters obtained by measuring isovolumic relaxation time and transmitral flow velocity often give inaccurate information. Using LV pressure curve, pulsed Doppler echocardiography, and pulsed Doppler tissue imaging in 38 patients with heart disease and 12 control subjects, we calculated the time constant and recorded transmitral flow velocity and motion velocities at the endocardial portions of the ventricular septum and LV posterior wall. Compared with the controls, patients exhibited a prolonged time constant, a decreased peak early diastolic velocity of the LV posterior wall, and a prolonged time interval from the second heart sound to the peak of the early diastolic wave. The time constant correlated well with the isovolumic relaxation time and various parameters calculated from the transmitral flow velocity, except in patients with elevated LV end-diastolic pressure. In all subjects, the time constant correlated negatively with the peak early diastolic velocity of the posterior wall and positively with the time from the second heart sound to the peak of the early diastolic wave. Thus, early diastolic parameters derived from the motion velocity of the LV posterior wall by pulsed Doppler tissue imaging were closely related to the time constant. This technique may allow noninvasive evaluation of abnormal LV relaxation in patients with various heart diseases.

We assessed left ventricular (LV) relaxation in 38 patients with heart disease using pulsed Doppler tissue imaging. The time constant correlated negatively with the peak early diastolic velocity and positively with the time from the second heart sound to the peak of the early diastolic wave in all patients. Doppler tissue imaging can noninvasively determine abnormal LV relaxation.

Section snippets

Study Population

We performed routine echocardiography, left cardiac catheterization, and coronary angiography in 100 consecutive Japanese patients with suspected cardiovascular disease based on clinical symptoms such as chest pain and dyspnea, abnormal findings in the electrocardiogram, cardiomegaly in the chest radiograph, and heart murmurs during auscultation. In 50 (32 men and 18 women, age range 39 to 72 years, mean 54 ± 9) of the 100 patients, LV pressure curves were recorded using a high-fidelity

Clinical Data

The group of patients with heart disease and the control group did not differ significantly as to age or heart rate (Table 1). The 38 patients were classified into 2 groups with respect to transmitral flow velocity patterns. Nine patients (5 with dilated cardiomyopathy, 2 with ischemic cardiomyopathy, and 2 with cardiac amyloidosis) exhibited a pseudonormalized pattern; that is, the ratio of the peak velocity of the atrial systolic wave to the peak velocity of the early diastolic wave (A/E) was

Discussion

To evaluate the diastolic function of the LV accurately, it is necessary to assess LV relaxation at the isovolumic diastole as well as LV filling, which, in turn, is determined by the relationship between LV volume and pressure after opening of the mitral valve.[1] LV relaxation abnormalities sometimes appear before the occurrence of LV systolic dysfunction.1, 2, 3 Moreover, these abnormalities have been reported to develop with age even in healthy subjects.20, 21 The time constant calculated

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