Is the Blood Flow in the Left Ventricle during the Isovolumic Relaxation Period a Useful Parameter of Left Ventricular Systolic and Early Diastolic Performance?

Abstract

Left ventricular (LV) early diastolic performance is determined by LV behavior in the late systole to early diastole and may relate to the physical potential of patients. Isovolumic relaxation flow (IRF) velocity was obtained by continuous Doppler echocardiography in the left ventricle from the apex in 26 patients with atypical chest pain and 63 patients with coronary artery disease (CAD) with or without prior myocardial infarction (MI) who underwent cardiac catheterization. In each patient, a time constant of LV relaxation (τ) was calculated from the LV pressure waves obtained by a catheter-tipped micromanometer. The LV end-systolic volume index was measured using contrast left ventriculography. IRF velocity in patients having CAD with prior MI (24.8 ± 5.4 cm/s) was significantly less than in those with atypical chest pain (41.2 ± 9.6 cm/s). It was also significantly less than in patients having CAD without prior MI (37.3 ± 6.8 cm/s). IRF velocity significantly correlated with the time constant τ (r = –0.42, p < 0.001) and LV end-systolic volume index (r = –0.84, p < 0.001). This study indicates that IRF velocity obtained by continuous Doppler echocardiography in the left ventricle provides important information regarding LV systolic performance and early diastolic performance.

Intraventricular Isovolumic Relaxation Flow Patterns Improve the Predicting Power of Doppler Echocardiography for the Left Ventricular Filling Pressure in Patients with Anterior Wall Myocardial Infarction

“…1, lower panels). In previous studies, a ‘toward the apex (red colored)’ IVR flow could be demonstrated in all of the 18 normal persons [17]and 26 patients with atypical chest pain [18]. In our echocardiographic laboratory, this IVR flow could be also demonstrated in all of the 106 clinically healthy persons (V max : 35.0 ± 11.2 cm/s).…”

Intraventricular Isovolumic Relaxation Flow Patterns Studied by Using Vector Flow Mapping

“…Recently, the events during the IVR period have been scrutinized as heralding changes in LV function. The duration and velocity of IRF have been shown to be useful in the noninvasive estimation of LV systolic and early diastolic performance …”

“…The color M‐mode Doppler, pulsed‐wave Doppler, and continuous wave Doppler echocardiographies, with their high sampling rates, have been used to measure peak velocity, direction, and duration of IRF. However, these methods provide only one‐dimensional velocity information on the M‐mode or Doppler cursor; therefore, they are insufficient in the identification of intraventricular flow in both temporal and spatial distributions.…”

High Prevalence of Isovolumic Relaxation Flow in Healthy Subjects

“…Although the transmitral E‐to‐A wave velocity ratio also correlated with the IRF velocity, there was no significant correlation between the IRF velocity and the left ventricular inflow propagation velocity, a noninvasive index of left ventricular relaxation 19 . Ohte et al showed a lower IRF velocity in patients with coronary artery disease than patients with atypical chest pain 13,14 . Furthermore, IRF velocity showed a positive correlation with left ventricular ejection fraction and a negative correlation with left ventricular end‐systolic volume index 13 .…”

“…The duration of IRF was shown to be useful for estimating left ventricular relaxation property noninvasively 12 . In addition, its velocity was demonstrated to be a useful parameter of left ventricular systolic and early diastolic performance 13,14 . Age is associated with changes in left ventricular diastolic filling, 15,16 but not with changes in systolic performance 16 .…”