(Circulation. 1999;99:2048-2054.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Mechanisms of Retarded Apical Filling in Acute Ischemic Left Ventricular Failure
From the Institute for Surgical Research, Rikshospitalet, Oslo, and Medical Department, Aker University Hospital, University of Oslo, Norway.
Correspondence to Prof Otto A. Smiseth, Institute for Surgical Research, Rikshospitalet, N-0027 Oslo, Norway. E-mail o.a.smiseth{at}rh.uio.no
Background—We examined the hypothesis that retardation of apical filling as measured by color M-mode Doppler echocardiography in the diseased left ventricle (LV) reflects a decrease in the intraventricular mitral-to-apical pressure gradient.
Methods and Results—In 9 open-chest anesthetized dogs,
micromanometers were placed near the mitral tip and
in the apical region. From the color M-mode Doppler images, the
time delay (TD) between peak velocity at the mitral tip and the apical
region was determined as an index of LV flow propagation. Acute
ischemic LV failure was induced by coronary
microembolization. Induction of ischemia caused a marked
increase in LV end-diastolic pressure and a decrease in LV
ejection fraction. The time constant of LV isovolumic apical pressure
decay (
) increased from 31±8 to 49±16 ms
(P<0.001). The peak early diastolic
mitral-to-apical pressure gradient (
PLVmitral-apex)
decreased from 1.9±0.9 to 0.7±0.5 mm Hg
(P<0.01), and TD increased from 5±3 to 57±26 ms
(P<0.001). The slowing of flow propagation was limited
to the apical portion of the LV cavity. The TD correlated with
PLVmitral-apex (r=-0.94,
P<0.01) and with (r=0.92,
P<0.01). Before ischemia, the mitral-to-apical
flow propagation velocity far exceeded the velocity of the individual
blood cells, whereas during ischemia, flow propagation velocity
approximated the blood velocity.
Conclusions—Retardation of apical filling in acute ischemic failure was attributed to a decrease in the mitral-to-apical driving pressure, reflecting slowing of LV relaxation. The slowing of flow propagation appeared to represent a shift in apical filling from a pattern of column motion to a pattern dominated by convection.
Key Words: diastole • echocardiography • ischemia • heart failure • pressure
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