Quality of life assessment after successful percutaneous transmitral commissurotomy and ascertain its relationship with gender / Evaluación de la calidad de vida tras comisurotomía mitral percutánea exitosa y determinación de su relación con el sexo

Abstract Background: percutaneous transmitral commissurotomy has become an ideal treatment option for mitral stenosis due to its less adverse events and more favorable outcomes. Patients improve symptomatically after percutaneous transmitral commissurotomy but we have minimal available data about the quality of life after percutaneous transmitral commissurotomy. Objective: to assess the quality of life after percutaneous transmitral commissurotomy through WHOQol scoring covering different aspects of life, to determine its correlation with a net gain in mitral valve area (MVA) and to ascertain its association with gender. Methods: it was a prospective cohort study carried out for a period of 15 months. A total of 100 patients with mitral stenosis who had successful percutaneous transmitral commissurotomy done were enrolled in the study. Among the total included, 4 patients were lost to follow up and data were collected from 96 patients. Quality of life was assessed before the procedure, at 1 month and 3 months follow up after percutaneous transmitral commissurotomy using WHOQol scoring questionnaire. Results: among 96 patients, 64 (67%) were females and 32 (33%) were males. WHOQol scoring improved significantly after percutaneous transmitral commissurotomy from 32.8±8.9 to 54.6±11.2 and 62.8± 9.7, after one month and 3 months respectively. There was a significant association between net gain of MVA and WHOQol scoring with an R value of 0.46 and p value of 0.03. There was no difference in group comparison of all the six domains between male and female patients. Conclusion: successful percutaneous transmitral commissurotomy improves the quality of life in mitral stenosis patients regardless of their gender and has a positive correlation with a net gain in mitral valve area.

Resumen Antecedentes: La comisurotomía mitral percutánea se ha convertido en una opción terapéutica ideal para la estenosis mitral, debido a efectos menos adversos y a resultados más favorables. Los pacientes mejoran sintomáticamente tras la realización de esta técnica, aunque se dispone de escasos datos acerca de la calidad de vida tras su puesta en práctica. Objetivo: Evaluar la calidad de vida tras la comisurotomía mitral percutánea mediante la puntuación WHOQol, que cubre diferentes aspectos de la vida, para determinar su correlación con la ganancia neta del área valvular mitral (AVM), y determinar su asociación con el sexo. Métodos: Estudio prospectivo de cohorte durante un periodo de 15 meses, en el que se incluyeron 100 pacientes con estenosis mitral a quienes se les practicó con éxito comisurotomía mitral percutánea. De entre el total incluido, se perdieron 4 pacientes durante el estudio, por lo que se recolectaron datos de los 96 pacientes restantes. La calidad de vida se evaluó antes del procedimiento, y transcurridos un mes y tres meses de seguimiento, utilizando el cuestionario de puntuación WHOQol. Resultados: De los 96 pacientes, 64 (67%) eran mujeres y 32 (33%) varones. La puntuación WHOQol mejoró considerablemente tras la realización de la comisurotomía mitral percutánea, con valores de 32,8±8,9 a 54,6±11,2 y 62,8± 9,7, transcurridos uno y 3 meses, respectivamente. Se produjo una asociación significativa entre la ganancia neta de AVM y la puntuación WHOQol, con un valor R de 0,46 y un valor p de 0,03. No se produjo diferencia alguna en cuanto a la comparación grupal de los seis dominios entre varones y mujeres. Conclusión: La comisurotomía mitral percutánea exitosa mejora la calidad de vida de los pacientes de estenosis mitral, independientemente del sexo, y tiene una correlación positiva con la ganancia neta del área valvular mitral.

Maniobra de handgrip y patrón pseudonormal del flujo transmitral en pacientes jóvenes con corazón estructuralmente sano / Handgrip maneuver and pseudonormal transmitral flux pattern in young patients with a structurally healthy heart

El flujo transmitral, a pesar de que su sóla modificación ya no representa un criterio para definir disfunción diastólica, sigue siendo el primer paso para el diagnóstico. El patrón pseudonormal sigue siendo un reto en cuanto a su diferenciación con el patrón normal o anormal en la población, sin embargo resulta interesante conocer la prevalencia de este patrón en poblaciones jóvenes con corazón estructuralmente sano. Para ello, se realizó un estudio descriptivo transversal en 38 pacientes jóvenes con corazón estructuralmente sano, sin enfermedades cardiovasculares previamente diagnosticadas, que acudieron al Centro Cardiovascular Regional ASCARDIO en el período enero-marzo 2019. Se practicó un ecocardiograma transtorácico donde se realizaron determinaciones basales del flujo transmitral y posterior a la aplicación de la maniobra de Handgrip. Los resultados demuestran que el 68% de los pacientes mostraron patrón pseudonormal del flujo transmitral. Al momento de realizar la maniobra de Handgrip, el 84% de los individuos mostraron un patrón de flujo normal mientras el 6% correspondieron a patrón pseudonormal siendo la distribución por sexo equitativa para cada categoría. La maniobra de Handgrip resulta útil para desenmascarar el patrón pseudornomal a normal del flujo transmitral y en sentido contrario, en pacientes con corazón estructuralmente sano(AU)

Transmitral flow, although its single modification no longer represents a criteria to define diastolic dysfunction, remains the first step for diagnosis. The pseudonormal pattern remains a challenge in terms of its differentiation with the normal or abnormal pattern in the population, however it is interesting to know the prevalence of this pattern in young populations with structurally healthy heart. We performed a descriptive transversal study in 38 patients with a structurally healthy heart and no known cardiovascular disease, who attended the Regional Cardiovascular Center ASCARDIO in the period January-March 2019. A transthoracic echocardiogram was performed where baseline determinations of transmitral flow and subsequent to the application of the Handgrip maneuver were made. The results show that 68% of patients had a pseudonormal pattern of transmitral flow. After performing the Handgrip maneuver, 84% of the individuals showed a normal flow pattern while 6% had a pseudonormal pattern, with an equal distribution by sex. Handgrip maneuver is useful to unmask the pseudonormal to normal pattern of transmitral flow and in the opposite direction, in patients with structurally healthy heart(AU)

A curious case of raised gradient across mitral bioprosthetic valve

High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.

The analysis on clinical characteristics and risk factors in patients with sepsis-associated pulmonary hypertension / 中华急诊医学杂志

Objective To analyze clinical characteristics and risk factors of pulmonary hypertension (PH) in patients with sepsis.Methods According to retrospective analysis of clinical data 136 cases with sepsis were divided into PH group and non-PH group.The clinical data,laboratory findings and ultrasonic cardiographic findings were recorded and compared between two groups.Multi-factors Logistic regression analysis was performed to find the independent risk factors of PH in patients with sepsis,and receiver operating characteristic curve ROC was constructed to indicate the predictable value.Results Of 136 patients with sepsis,32 (23.5％) developed PH.The PH group had higher NT-proBNP [lgNT-proBNP (3.67±0.41) vs.(3.33±0.59),P=0.003],higher E peak [(86.12±30.43) vs.(67.73±21.49),P=0.008],higher E/A peak [(1.09±0.46) vs.(0.83±0.29),P=0.014],higher left atrium diameter (LAD) [(36.49±5.97) vs.(31.32±4.69),P=0.001] and lower oxygenation index [(291.90±51.62) vs.(326.40±88.16),P=0.017] than the non-PH group (P ＜ 0.05).It was shown by multi-factors Logistic regression analysis that LAD (OR=1.198,P=0.010) was an independent risk factor of PH in patients with sepsis.The area under the curve AUC of LAD was 0.723,with the cut-off value of 31 mm (sensibility 82.6％,specificity 49.0％).Conclusions LAD was an independent risk factor of sepsis-associated pulmonary hypertension in sepsis patients.

The value of serum N-terminal pro brain natriuretic peptide in predicting left ventricular diastolic dysfunction in septic shock patients / 中华急诊医学杂志

Objective To investigate the predictive value of serum N-terminal pro brain natriuretic peptide NT-proBNP in left ventricular diastolic dysfunction(LVDD) in septic shock patients.Methods According to retrospective analysis of clinical data 96 patients with septic shock were divided into LVDD group and non-LVDD group.General clinical data,APACHE scores,NT-proBNP,Troponin I(TNI),creatinine,procalcitonin,D-dimer and lactic acid within the first 24 hours after admission were recorded,and multi-factors logistic regression analysis was conducted to find independent risk factors for left ventricular diastolic dysfunction in septic shock patients Receiver operating characteristic curve ROC was constructed to indicate the predictive value.Results There were no significant differences in general clinical data,procalcitonin,D-dimer and lactic acid between two groups.Compared with non-LVDD group the levels of NT-proBNP [lgNT-proBNP (3.66±0.38) vs.(3.03±0.59),P =0.000],TNI [lgTNI(-1.45±0.86)vs.(-2.36±0.82),P ＜ 0.01] and creatinine [(186.12±124.24)vs.(101.16±57.01),P ＜ 0.01] in LVDD group were significantly higher.It was shown by multi-factors logistic regression analysis that NT-proBNP (OR=8.731,95％CI;1.541-49.466,P=0.014) was an independent risk factor for left ventricular diastolic dysfunction in septic shock patients.The area under the curve AUC of NT-proBNP was 0.813 with the cut-off value of 1 725 pg/μL,sensibility =88.6％,specificity =62.1％.Conclusion NT-proBNP was avaluable indicator in predicting left ventricular diastolic dysfunction in septic shock patients.

Significance of the disagreement between transmitral pulsed wave Doppler and mitral annulus tissue Doppler imaging in the estimation of left ventricular filling pressures / 中国医学影像技术

Objective To explore the clinical significance of the disagreement between transmitral pulsed wave Doppler (PWD) and mitral annulus Doppler tissue imaging (DTI) in the estimation of left ventricular (LV) filling pressures. Methods One hundred and eighty-two sinus rhythm patients without arrhythmia, congenital heart disease and valvular disease underwent routine echocardiography and synchronous electrocardiogram for assessment of LV function. Early and late diastolic velocities of LV, which were composed of e and a waves, were recorded using DTI at the mitral annulus. Six sites at the mitral annuli were selected corresponding to the septal, lateral, anterior septal, posterior, inferior, and anterior walls of LV from apical 4-, 3-and 2-chamber views. Transmitral diastolic flow velocity, which was represented by E and A wave, was measured with PWD from apical 4-chamber view. Ratio of early and late diastolic transmitral valve (MV-E/A), ratio of DTI-e/a-ann and ratio of E/e-ann were calculated, respectively. The mean value of e-ann from the above 6 sites was selected to describe the early diastolic velocities of mitral annular. Results According to the results of MV-E/A ratio and DTI-e/a-ann ratios of the 6 sites, these 182 patients were divided into 4 groups: groupⅠ(n=68): MV-E/A＜1.0, DTI-e/a-ann＜1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 0.71±0.16 and mean E/e-ann ratio 15.91±6.78; groupⅡ(n=38): MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 0.76±0.12 and mean E/e-ann ratio 10.37±2.63; group Ⅲ(n=23): MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time, with mean MV-E/A ratio being 1.74±0.42 and mean E/e-ann ratio 9.57±2.39; group Ⅳ(n=53): MV-E/A≥1.0, DTI-e/a-ann＜1.0 at 1-6 sites among the total sites, with mean MV-E/A ratio being 1.31±0.31 and mean E/e-ann ratio 13.27±9.46. The mean ages of group Ⅰ, Ⅱand Ⅳ were older than that of group Ⅲ. Although there was no obvious difference between group Ⅰand groupⅡ in the mean age and mean MV-E/A (P＞0.05), the mean E/e-ann was much higher in group Ⅰthan that in groupⅡ (P＜0.05). The mean MV-E/A was similar in group Ⅲ and group Ⅳ (P＞0.05), but the mean age and mean E/e-ann in the latter were older and higher than those in the former (P＜0.05), respectively. The mean age in group Ⅳ was younger than that in group Ⅰand Ⅱ, while the mean E/e-ann in group Ⅳ was higher than that in group Ⅱ, but lower than group Ⅰ (P＜0.05). Conclusion ①Ratio of MV-E/A ＜1.0 and ratios of DTI-e/a-ann ＜1.0 at all the 6 sites indicates increasing LV filling pressures; ②MV-E/A≥1.0 and DTI-e/a-ann＜1.0 at 1-6 sites among the total sites predicts a tendency of high LV filling pressures; ③Wide variability may present in those with MV-E/A＜1.0, DTI-e/a-ann≥1.0 at 1-6 sites among the total 6 sites or MV-E/A≥1.0, DTI-e/a-ann≥1.0 at all the 6 sites at the same time; ④Age of the patient has great influence on the measurement of MV-E/A ratio and DTI-e/a-ann ratio.

Dynamics of Left Ventricular Diastolic Filling during Progressive Exercise / 中国运动医学杂志

This study was to assess diastolic filling dynamics of the left ventricle during progressive upright cycle exercise in young men. The results showed that the diastolic filling period shortened from 0.581?0.14s at rest to 0.129?0.04s at peak exercise; the peak transmitral flow velocities increased from 0.72?0.07m/s at rest to 1.60?0.10m/s at peak exercise and the mean transmitral flow velocities increased from 0.41?0 03m/s at rest to 0.96?0.13m/s at peak exercise; the peak and mean transmitral pressure gradients rose fivefold from rest to peak exercise; the mitral flow volume per beat rose by 38% at 100W workloads and then remained stable. Conclusions Increases in transmitral pressure gradients with exercise may serve principally to augment the velocity of ventricular filling with the progressively shortening diastolic time period.

The Relationship between the Excursion of Mitral Valve Leaflets Recorded by M-Mode Echocardiography and the Transmitral Inflow Measured by Doppler Echocanliography

BACKGROUND AND OBJECTIVES: Movement of mitral valve during diastole and blood flow velocity through the valve can be accurately measured using M-mode and pulsed wave Doppler technique, respectively. However, the relationship between mechanical excursion and flow phenomenon at the same cardiac cycle has not been seriously investigated. METHOD: The subjects of this study included twenty cases with normal mitral flow pattern in Doppler echocardiography (Group I, mean age:44+/-20.8years, mean ejection fraction (EF):52+/-20.9%), twenty three cases with relaxation abnormality (Group II, mean age:59+/-11.4years, mean EF:43+/-18.2%) and seventeen cases with restrictive physiology (Group III, mean age: 47+/-15.9years, mean EF: 24+/-11.0%). We measured excursion of mitral leaflets at early (DE) and late (DA) diastole, area of mitral valvular opening using two dimensional calibration on M mode images, and transmitral inflow velocity (E (early ventricular filling)-, A (atrial contraction)-velocity), TVI (time velocity integral) on Doppler echocardiography. RESULTS: DE-excursions (mm) in group I, II, III were 16.8+/-4.7, 14.2+/-3.5, 15.3+/-4.1, DA-excursions (mm) were 9.8+/-3.2, 10.7+/-3.0, 8.3+/-2.7, E-areas (cm2) were 2.8+/-1.3, 2.6+/-0.8, 2.5+/-1.0, A-areas (cm2) were 1.7+/-0.8, 1.7+/-0.7, 2.0+/-0.6, respectively. In E-, A-velocity, deceleration time, E-TVI and A-TVI, there were significant differences among three groups. However, in DE-, DA-excursion, E-, A-area, there were no significant differences among three groups. Between DE excursion and E velocity, DA excursion and A velocity, and total opening area and total TVI in total subjects, significant correlations were absent. CONCLUSION: The mitral excursions and mitral opening areas on M mode images did not show any significant correlations with the mitral inflow velocities and TVI by pulsed Doppler, which suggests that the excursion of mitral leaflets is independent of transmitral inflow.

Long-term Clinical Outcome and Echocardiographic Restenosis after Successful Percutaneous Transmitral Commissurotomy

BACKGROUND: The purpose of this study was to assess the clinical outcome and echocardiographic incidence of restenosis after successful percutaneous transmitral commissurotomy (PTMC) and to identify predictors of restenosis. METHODS: Between 1989 and 1992, Inoue PTM (n=73) and double balloon technique (n=85) were used in 158 consecutive patients (male 52, age; 41+/-11 year) with mitral stenosis. Clinical and echocardiographic examinations were performed annually in 137 patients who exhibited good initial result with PTMC (mitral valve area 1.5cm (2) and mitral regurgitation[MR] 2+). Restenosis was defined as a mitral valve area< (MVA) 1.5cm (2) or more than 50% loss of the initial gain in MVA. Commissural mitral regurgitation (CMR) was defined as MR originating from medical or lateral commissure on color flow imaging and regarded as an index of complete commissural splitting. RESULTS: Immediately after PTMC, MVA increased from 0.9+/-0.2cm (2) to 1.8+/-0.3cm (2) and functional class improved up to NYHA class 1 or 2 in all patients. Annual echocardiographic follow-ups were completed in 129 (94%) patients and mean follow-up duration was 54+/-21 months. Adverse events occurred in 16 (13%) patients (1 death, 3 mitral valve replacement, 3 re-PTMCs, 9 deterioration of the NYHA class), and restenosis occurred in 41 (32%) patients. Event-free and restenosis-free survival rates at 7 years were 776 % and 586 %, respectively. According to multivariate Cox analysis, restenosis (p=0.0017, relative risk[r.r]=2.82) was the only predictor of adverse events ; smaller increase ( 1.0cm (2)) of MVA (p=0.0001, r.r=4.8) and the absence of CMR (p=0.0000, r.r=4.8) were independent predictors of restenosis. CONCLUSION: Long-term clinical outcomes and restenosis rates after PTMC are favorable and immediate results after PTMC can predict late restenosis better than baseline clinical and echocardiographic characteristics.

Clinical Status in Patients Who Restrictive Pattern on Doppler Transmitral Flow Pattern

BACKGROUND: Restrictive pattern on Doppler transmitral flow pattern represent reduced left ventricular compliance and associated with poor prognosis in patients with systolic dysfunction due to congestive heart failure or myocaridal infarction. Although there are many clinical evaluation about clinical significance of restrictive transmitral flow pattern, investigation about what kinds of disease reveal the characteristic restrictive transmitral flow pattern and significance according to criteria of restrictive transmitral flow pattern is few. Therefore, we have analyzed patients with restrictive transmitral flow pattern in order to evaluate clinical diagnosis and clinical significance according to criteria of restrictive transmitral flow pattern. METHODS: The study population consisted of 229 patients(male 129 patients, female 102 patients, mean age 40.6 years old) who show E/A ratio p 2 on Doppler echocardiography from september 1994 to aprial 1996. We have reviewed the medical records of that patients. RESULTS: 1) In case of patients more than 2 at E/A ratio, we found that subjects not related with cardiovascular diseases were 76 persons(33.2%), valvular heart disease 75 patients(32.3%), ischemic heart disease 25 patients(10.9%), cardiomyopathy 16 patients(6.9%). Among valvular heart disease, mitral regurgitation was most frequently observed(44.5%). In these patients, patients with left ventricular systolic dysfunction were 60 patients(26.2%). 2) Patients more than 2 at E/A ratio and less than 150msec at deceleration time of E wave were 126 patients(55.0%). In these patients, we found that valvular heart disease was also most frequently observed(49 patients, 38.8%), subjects not related with cardiovascular diseases 30 persons(23.8%), cardiomyopathy 15 patients(11.9%),pericarditis 7 patients(5.6%), hypertension 3 patients(2-3%). Patients with left ventricular systolic dysfunction in this group were 39 patients(31.0%). CONCLUSION: Although restrictive transmitral flow pattern on Doppler echocardiography represents reduced compliance of left ventricle or severe heart failure in patients with symptoms of congestive heart failure, this pattern also may be seen in persons not related with cardiovascular disease. Therefore, when making dicision about clinical significance of restrictive pattern, one should consider about any factors can influece the transmitral flow pattern and correlate the clinical diagnosis with mitral flow velocity.

Serial Changes of Transmitral Inflow Patterns after Acute Myocardial Infarction

BACKGROUND: Although determination of Doppler echocardiographic transmitral inflow patterns(DETIP) is used as an indrect method assessing LV diastolic function. It is known that DETIP can be affected by certain hemodynamic variables. The aim of this investigation is to assess the serial changes of DETIP and to determine the relation of DETIP with clinical parameter such as initial left ventricular end-diastolic volume(LVEDV), ejection fraction(EF), Killip class and thrombolytic therapy in acute myocardial infarction (AMI) patients. METHOD: Four serial Doppler and 2-D echocardiographic studies were performed at 1 day, 1 week, 1mouth, and 3 months after development of AMI in 24 patients(M:F=19:5, aged 58+/-11 year , 15 anterior MI) and 13 normal adults (aged 47+/-9 years) as reference group. On admission 14 patients were in Killip class I and 10 patients in class II. Thrombolytic therapy with IV urokinase were done in 11 patients. E velocity, pressure half-time (PHT), and isovolumic relaxation time(IVRT) were analyzed and LV systolic function was determined in apical 4 chamber view. RESULTS: DETIP did not change until 1month after development of AMI. However, E/A ratio was decreased, and PHT and IVRT were increased at 3 months after AMI. Doppler transmitral flow parameters were not related with Killip class and LV systolic function. Patiens who recieved urokinase intravenously and who had greater intial LVEDV(>118cm3) showed higher E/A ratio and shorter PHTand IVRT than those who did not. These findings indicate that changes in Doppler transmitral inflow pattern in AMI patients are not uniform over a period of 3 months and thrombolytic therapy causes favorable effect on Doppler transmitral flow parameters. CONCLUSION: Changes in Doppler trasmitral inflow pattern may be variable over post-AMI period and this should be taken into account in evaluating LV diastolic function after AMI. Thrombolytic therapy may improve LV diastolic function in AMI patients.

The Pattern of Pulmonary Venous Flow in Various Heart Disease

To evaluate the influencing factors on pulmonary venous flow(PVF) pattern, we studied the relationship between PVF and left ventricular ejection fracton(EF), mitral annulus motion(MAM) and transmitral flow using pulsed doppler echocardiography in patients with dilated cardiomyopathy(DCMP), acute myocardioal infarction(AMI), left ventricular hypertrophy(LVH) and atrial fibrillation(AE). Ther results were as follows : 1) In the normal controls(13 cases), two forward flow during ventricular systole(VS) and diastole(VD) and one retrograde flow during atrial systole(AS) were observed. The peak velocity of VS, VD and AS flow was 45.9cm/s, 42.8cm/s and -18.3cm/sec, respectively. The peak VS/VD ratio was 1.1. 2) In patients with DCMP(11 cases), (a) compared to the noraml subjects, the peak velocity of VS flow and VS/VD ratio were were significantly reduced(p<0.005 and p<0.001, respectively) and were positively correlated with ejection fraction(r=0.8 and r=0.7, respectively) (b) in 2 DCMP cases with severe mitral regurgitation, systolic retrograde flow was observed in the pulmonary vein instead of forward VS flow. 3) In 12 AMI cases and 7 LVH cases with normal or slightly diminished left ventricular systolic function but with abnormal diastolic function. (a) the peak velocity of VS flow and peak VS/VD ratio were significantly increased(r<0.005 and p<0.01, respectively). (b) the peak velocity of VD flow is positively correlated with transmitral E/A ratio(r=0.8) and the peak VS/VD ratio was positively correlated with transmitral pressure half time(r=0.8). (c) the peak velocity of retrograde AS flow was significantly increased(p<0.001). (d) there was no correlation between doppler parameters of PVF and left ventricular ejection fraction. 4) In patients with atrial fibrillation(10 cases), VS flow was markedly diminished or absent and only VD flow was observed. Also, retrograde AS flow was not observed. These findings suggest that the pattern of PVF is influnced by LVEF, MAM, transmitral inflow and atrial contraction. However, main contributary factors in determining the pattern of PVF in each disease are diverse according to its main pathophysiology.

Reconstruction of the Transmitral Flow Rate Curve with M-Mode,2-Dimensional and Doppler Echocardiography -Validation Study-

To validate ventricular diastolic phase parameters of reconstructed transmitral flow rate curve by M-mode, 2-dimensional and pulsed Doppler Echocardiography, these parameters were compared with same parameters by left ventriculography. The study population was 22 patients who received both coronary arteriography and echocardiographic examination. Transmitral flow rate curve and left ventricular filling volume curve were reconstructed from transmitral flow velocity curve by pulsed Doppler, mitral annulus diameter by two diameter by two dimensional and diastolic motion of both mitral leafltes by M-mode echocardiography. From left ventriculography, left ventricular filling volume curve and transmitral flow rate curve were made using area-length method by Sandler and Dodge. From trasmitral flow fraction, 1/2 diastolic time filling fraction, normalized peak filling volume, 1/3 diastolic time filling fraction, 1/2 diastolic time fraction, normalized peak early filling rate and ratio of early to late peak filling rate were measured. Correlation between same parameters derived from echocardiography and left ventriculography were observed. 1) Total diastolic filling volume:correlation coefficient r=0.47, P<0.05. 2) 1/3 diastolic time filling fraction:correlation coefficient r=0.90, P<0.001. 3) 1/2 diastolic time filling fraction:correlation coefficient r=0.80, P<0.001. 4) Normalized peak early filling rate:correlation coefficient r=0.57, P<0.01. 5) Ratio of early to late peak filling rate:correlation coefficient r=0.85, P<0.001. Therefore, left ventricular diastolic phase parameters of reconstructed transmitral flow rate curve using, M-mode, 2-dimensional and pulsed Doppler echocardiography seems to be useful for the noninvasive evaluation of the left ventricular diastolic function.