Mid-Diastolic Flow in Health and Disease

No abstract available.

Relationship of Regional Early Diastolic Flow Velocity to Left Ventricular Hemodynamic Indices using Conventional Pulsed Doppler Method

BACKGROUND: Doppler echocardiography is widely used for the noninvasive evaluation of left ventricular diastolic function. More recently, it has attempted to indirectly assess left hemodynamic status by using different measurements obtained from puled wave Doppler ultrasound mitral flow recordings. However, the mitral flow velocity pattern is affected by several physiologic factors and change to normalized or restricutve pattern, Thus, this study designed to assess the relatioship between intraventricular dispersion of early diastolic flow velocity and hemodynamic variables. METHOD: The study population consisted of 8 patients with atypical chest pain, 8 patients with stable angina pectoris, 10 patients with myocardial infarction and 4 patients with dilated cardiomyopathy. Left ventricular catheterization was performed with fluid-filled catheter and left ventricular systolic pressure(LVSP), left ventricular end diastolic pressure(LVEL), -peak/dP/dt, and +peak dP/dt were measured, the mitral flow velocity was recorded at mitral valve tip and regional left ventricular diastolic flow velocity was recored at 1cm, 2cm and 3cm from mitral valve tip to the apex. Regional left ventricular early diastolic flow velocity was expressed as percentage to the early diastolic flow velocity in mitral valve tip(%Ex=(peak Ex/peak E)×100, %VTIEx=VTIEx/VTIE)×100, x=cm from mitral valve tip). RESULTS: There were modest negative correlations between %E2, %E3 and left ventricular end-diastolic pressure, respectively ; r=−0.62, −0.46. Modest negative correlation was found between %VTIE2 and LVEDP(r=0.42). %E2 15mmHg with a sensitivity of 74% and specificity of 77%. CONCLUSION: Propagation of left ventricular filling flow veolcity in early diastole is correlate with left ventricular end-diastolic pressure and %E2 is a relatively useful index of elevated left ventricular end-diastolic pressure.

The Effects of Handgrip and Cold Pressor Test on Mitral Flow in Patients with Left Ventricular Hypertrophy

BACKGROUND: Handgrip and cold pressor test may increase the afterload of the heart. And in left ventricular hypertrophy, it is known that mitral flow pattern is affected by decreased left ventricular compliance. We investigated the effects of handgrip and cold pressor test on mitral flow pattern in patients with left ventricular hypertrophy. METHODS: Handgrip and cold pressor test were performed in 12 subjects with left ventricular hypertrophy and in 14 healthy normal subjects. In supine position, blood pressure, heart rate and Doppler echocardiographic parameters(early peak flow velocity : E, atrial peak flow velocity : A) were obtained at rest, 1 and 3 minutes after the onset of tests respectively. RESULTS: In both groups, handgrip and cold pressor test increased blood pressure slightly without a statistical significance. In left ventricular hypertrophy group, there were significant increments in heart rates at 1 minute of handgrip (78+/-12min-1, p<0.001) and cold pressor test(77+/-7min-1, p<0.05) as compared to that at rest (73+/-12min-1). Mitral flow velocities did not show significant change after the tests in control group. A waves after 1 minute of handgrip(85.2+/-18.4cm/sec, p<0.05) and cold pressor test (87.3+/-17.8cm/sec, p<0.001) showed significant increases as compared to that at rest (79.1+/-14.9cm/sec) in left ventricular hypertrophy group whereas E waves did not. CONCLUSION: Although handgrip and cold pressor tests did not affect the mitral flow significantly in control group, each test raised A waves in left ventricular hypertrophy group. These results suggest that increased A waves may be due to a rise in afterload and decreased left ventricular compliance caused by handgrip and cold pressor test in left ventricular hypertrophy group.