This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brickner, M. E. Articles by Starling, M. R. Search for Related Content PubMed PubMed Citation Articles by Brickner, M. E. Articles by Starling, M. R.

Circulation, Vol 81, 1277-1286, Copyright © 1990 by American Heart Association

ARTICLES

Dissociation of end systole from end ejection in patients with long- term mitral regurgitation

ME Brickner and MR Starling
Department of Internal Medicine, University of Michigan, Ann Arbor 48105.

To determine whether left ventricular (LV) end systole and end ejection uncouple in patients with long-term mitral regurgitation, 59 patients (22 control patients with atypical chest pain, 21 patients with aortic regurgitation, and 16 patients with mitral regurgitation) were studied with micromanometer LV catheters and radionuclide angiograms. End systole was defined as the time of occurrence (Tmax) of the maximum time-varying elastance (Emax), and end ejection was defined as the time of occurrence of minimum ventricular volume (minV) and zero systolic flow as approximated by the aortic dicrotic notch (Aodi). The temporal relation between end systole and end ejection in the control patients was Tmax (331 +/- 42 [SD] msec), minV (336 +/- 36 msec), and then, zero systolic flow (355 +/- 23 msec). This temporal relation was maintained in the patients with aortic regurgitation. In contrast, in the patients with mitral regurgitation, the temporal relation was Tmax (266 +/- 49 msec), zero systolic flow (310 +/- 37 msec, p less than 0.01 vs. Tmax), and then, minV (355 +/- 37 msec, p less than 0.001 vs. Tmax and p less than 0.01 vs. Aodi). Additionally, the average Tmax occurred earlier in the patients with mitral regurgitation than in the control patients and patients with aortic regurgitation (p less than 0.01, for both), whereas the average time to minimum ventricular volume was similar in all three patient groups. Moreover, the average time to zero systolic flow also occurred earlier in the patients with mitral regurgitation than in the control patients (p less than 0.01) and patients with aortic regurgitation (p less than 0.05). Because of the dissociation of end systole from minimum ventricular volume in the patients with mitral regurgitation, the end-ejection pressure-volume relations calculated at minimum ventricular volume did not correlate (r = -0.09), whereas those calculated at zero systolic flow did correlate (r = 0.88) with the Emax slope values. We conclude that end ejection, defined as minimum ventricular volume, dissociates from end systole in patients with mitral regurgitation because of the shortened time to LV end systole in association with preservation of the time to LV end ejection due to the low impedance to ejection presented by the left atrium. Therefore, pressure-volume relations calculated at minimum ventricular volume might not be useful for assessing LV chamber performance in some patients with mitral regurgitation.

This article has been cited by other articles:

				A N Borg, J L Harrison, R A Argyle, and S G Ray Left ventricular torsion in primary chronic mitral regurgitation Heart, May 1, 2008; 94(5): 597 - 603. [Abstract] [Full Text] [PDF]

				J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2008; 3(2008): 973 - 1012. [Full Text]

				J. Bermejo, J. L. Rojo-Alvarez, J. C. Antoranz, M. Abel, I. G. Burwash, R. Yotti, M. Moreno, M. A. Garcia-Fernandez, K. G. Lehmann, and C. M. Otto Estimation of the End of Ejection in Aortic Stenosis: An Unreported Source of Error in the Invasive Assessment of Severity Circulation, August 31, 2004; 110(9): 1114 - 1120. [Abstract] [Full Text] [PDF]

				J. I. Fann, N. B. Ingels Jr., and D. C. Miller Pathophysiology of Mitral Valve Disease Card. Surg. Adult, January 1, 2003; 2(2003): 901 - 931. [Full Text]

				F. A. Tibayan, D. T. M. Lai, T. A. Timek, P. Dagum, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller Alterations in left ventricular torsion in tachycardia-induced dilated cardiomyopathy J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 43 - 49. [Abstract] [Full Text] [PDF]

				M. Nagatsu, F. G. Spinale, M. Koide, H. Tagawa, G. DeFreitas, G. Cooper IV, and B. A. Carabello Bradycardia and the Role of {beta}-Blockade in the Amelioration of Left Ventricular Dysfunction Circulation, February 15, 2000; 101(6): 653 - 659. [Abstract] [Full Text] [PDF]

				M. R. Starling Effects of Valve Surgery on Left Ventricular Contractile Function in Patients With Long-term Mitral Regurgitation Circulation, August 15, 1995; 92(4): 811 - 818. [Abstract] [Full Text]