Circulation, Vol 78, 661-671, Copyright © 1988 by American Heart Association
M Courtois, SJ Kovacs Jr and PA Ludbrook
Effects of regional diastolic pressure differences within the left
ventricle on the measured transmitral pressure-flow relation were
determined by simultaneous micromanometric left atrial (LAP) and left
ventricular pressure (LVP) measurements, and Doppler echocardiograms in 11
anesthetized, closed-chest dogs. Intraventricular pressure recordings at
sites that were 2, 4, and 6 cm from the apex were obtained. Profound
differences between these sites were noted in the transmitral pressure
relation during early (preatrial) diastolic filling. In measurements from
apex to base, minimum LVP increased (1.6 +/- 0.7 to 3.1 +/- 0.8 mm Hg, mean
+/- SD); the time interval between the first crossover of transmitral
pressures and minimum LVP increased (31 +/- 3 to 50 +/- 17 msec); the slope
of the rapid-filling LVP wave decreased (74 +/- 13 to 26 +/- 5 mm Hg/sec);
the maximum forward (i.e., LAP greater than LVP) transmitral pressure
gradient decreased (3.6 +/- 1.3 to 2.1 +/- 0.7 mm Hg); the time interval
between the first and second points of transmitral pressure crossover
increased (71 +/- 9 to 96 +/- 13 msec); and the area of reversed (i.e., LVP
greater than LAP) gradient between the second and third points of
transmitral pressure crossover decreased (101 +/- 41 to 40 +/- 33 mm
Hg.msec). During atrial contraction, significant regional ventricular
apex-to-base gradients were also noted. The slope of the LV A wave
decreased (26 +/- 10 to 16 +/- 4 mm Hg/sec); LV end-diastolic pressure
decreased (8.1 +/- 2.0 to 7.4 +/- 2.0 mm Hg), and the upstroke of the LV A
wave near the base was recorded earlier than near the apex. All differences
were significant at the 0.05 level. Simultaneous transmitral Doppler
velocity profiles and transmitral pressures were measured at the 4-cm
intraventricular site. The average interval between the first and second
points of pressure crossover and between the onset of early rapid filling
and maximum E-wave velocity were statistically similar (81 +/- 13 vs. 85
+/- 12 msec; NS); and the average area of the forward transmitral pressure
gradient associated with acceleration of early flow was significantly
greater than the area of reversed gradient associated with deceleration of
early flow (133 +/- 36 vs. 80 +/- 46 msec.mm Hg; p less than
0.025).(ABSTRACT TRUNCATED AT 400 WORDS)
ARTICLES
Transmitral pressure-flow velocity relation. Importance of regional pressure gradients in the left ventricle during diastole
Washington University School of Medicine, Cardiovascular Division, St. Louis, MO 63110.
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