(Circulation. 1995;91:192-200.)
© 1995 American Heart Association, Inc.
Articles |
Noninvasive Assessment of Left Ventricular Relaxation Using Continuous-Wave Doppler Aortic Regurgitant Velocity Curve
Its Comparative Value to the Mitral Regurgitation Method
From the First Department of Medicine, Osaka University School of Medicine, Suita, Japan.
Correspondence to Tohru Masuyama, MD, The First Department of Medicine, Osaka University School of Medicine, 2-2, Yamadaoka, Suita 565, Japan.
Background The most established parameters of left ventricular (LV) relaxation are peak negative value of the first derivative of LV pressure (-dP/dtmax) and the time constant of isovolumic LV pressure fall. The instantaneous pressure gradient between the aorta and the LV during diastole can be calculated from the continuous-wave Doppler aortic regurgitant velocity spectrum. Because the fluctuation of aortic pressure during LV isovolumic relaxation is negligibly minor and because LV minimal pressure is negligibly low, LV pressure during the isovolumic relaxation period may be derived from the continuous-wave Doppler aortic regurgitant velocity spectrum. This study was designed to clarify whether analysis of continuous-wave Doppler aortic regurgitation recording provides accurate measures of LV relaxation over a wide range of LV function and to determine comparative values of aortic and mitral regurgitation methods in the assessment of LV relaxation.
Methods and Results In eight mongrel dogs with acute ischemic LV
dysfunction, the continuous-wave Doppler aortic regurgitant velocity
spectrum was recorded simultaneously with high-fidelity LV and aortic
pressures, while the continuous-wave Doppler mitral regurgitant
velocity spectrum was recorded simultaneously with high-fidelity left
atrial and LV pressures. The aortic regurgitant velocity spectrum was
provided for the determination of Doppler-derived mean rate of LV
pressure fall in 20 ms after the onset of aortic regurgitation
(
P/t-AR) and the time interval from the onset of aortic
regurgitation to the point at (1-1/e)1/2 of the
maximal aortic regurgitant velocity as an estimate of the time
constant. The mitral regurgitant velocity spectrum was provided for
Doppler-derived mean rate of LV pressure fall in 20 ms after the point
of -dP/dtmax (P/t-MR) and the time interval
from the point of -dP/dtmax to the point with
mitral regurgitant velocity of (1/e)1/2 of the
mitral regurgitant velocity at the point of
-dP/dtmax as an estimate of the time constant.
P/t-AR and P/t-MR correlated well with catheter-derived
-dP/dtmax (r=.92, r=.98,
P<.01, respectively). The time constant derived from aortic
and mitral regurgitant velocity spectra (tau-AR and tau-MR) also
correlated well with catheter-derived time constant (r=.84,
r=.76, P<.01, respectively). However, a mean
difference of the catheter-derived time constant minus tau-MR was
larger than tau-AR (29±30 versus 4±17 ms, P<.01,
presented as mean±2 SD).
Conclusions LV relaxation can be assessed from the continuous-wave Doppler aortic regurgitant velocity spectrum. The aortic regurgitation method provides an even more accurate estimate of the time constant compared with the mitral regurgitation method, particularly in the presence of LV dysfunction.
Key Words: regurgitation • echocardiography • diastole
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