Circulation, Vol 74, 187-196, Copyright © 1986 by American Heart Association
Y Ishida, JS Meisner, K Tsujioka, JI Gallo, C Yoran, RW Frater and EL Yellin
Peak rapid filling rate (PRFR) is often used clinically as an index of left
ventricular relaxation, i.e., of early diastolic function. This study tests
the hypothesis that early filling rate is a function of the
atrioventricular pressure difference and hence is influenced by the left
atrial pressure as well as by the rate of left ventricular relaxation. As
indexes, we chose the left atrial pressure at the atrioventricular pressure
crossover (PCO), and the time constant (T) of an assumed exponential
decline in left ventricular pressure. We accurately determined the
magnitude and timing of filling parameters in conscious dogs by direct
measurement of phasic mitral flow (electromagnetically) and high-fidelity
chamber pressures. To obtain a diverse hemodynamic data base, loading
conditions were changed by infusions of volume and angiotensin II. The
latter was administered to produce a change in left ventricular pressure of
less than 35% (A-1) or a change in peak left ventricular pressure of
greater than 35% (A-2). PRFR increased with volume loading, was unchanged
with A-1, and was decreased with A-2; T and PCO increased in all three
groups (p less than .005 for all changes). PRFR correlated strongly with
the diastolic atrioventricular pressure difference at the time of PRFR (r =
.899, p less than .001) and weakly with both T (r = .369, p less than .01)
and PCO (r = .601, p less than .001). The correlation improved
significantly when T and PCO were both included in the multivariate
regression (r = .797, p less than .0001). PRFR is thus determined by both
the left atrial pressure and the left ventricular relaxation rate and
should be used with caution as an index of left ventricular diastolic
function.
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Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure [published erratum appears in Circulation 1986 Sep;74(3):462]
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