Circulation, Vol 89, 553-557, Copyright © 1994 by American Heart Association
RG Pai, M Suzuki, JT Heywood, DR Ferry and PM Shah
BACKGROUND: Subjects in sinus rhythm have two distinct diastolic flow
velocities in the left ventricular (LV) outflow tract directed toward the
aortic valve. These follow E and A waves of the transmitral flow and are
referred to as Er and Ar waves, respectively. The A wave transit time from
the mitral valve to the LV outflow tract is shorter than that of the E wave
and is shorter in those with LV hypertrophy and the aged, suggesting its
possible dependence on LV late diastolic stiffness. METHODS AND RESULTS. We
measured the peak-to-peak and onset- to-onset A wave transit times from the
mitral valve to the LV outflow tract (AArp and AAro intervals,
respectively) using Doppler echocardiography in 20 patients undergoing left
heart catheterization for evaluation of coronary artery disease. These
intervals were correlated with indices of LV late diastolic stiffness
obtained from high-fidelity LV pressure tracings and angiographic volume
assessments. The AArp and AAro intervals correlated significantly with LV
Dp/DV (conventionally dP/dV) (r = -.68 and -.83, respectively), volume
stiffness, V.Dp/DV (r = -.74 and -.80, respectively) and LV (V/P) (Dp/DV)
(r = -.69 and -.74, respectively). The AAro interval correlated better with
the square roots of LV Dp/DV and volume stiffness (r = -.86 and -.87,
respectively). CONCLUSIONS: We conclude that AArp and AAro intervals are
easily obtainable Doppler parameters that reflect LV late diastolic
stiffness in patients with coronary artery disease and possibly in other
patients groups.
ARTICLES
Mitral A velocity wave transit time to the outflow tract as a measure of left ventricular diastolic stiffness. Hemodynamic correlations in patients with coronary artery disease
Department of Cardiology, Loma Linda University, Calif.
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