Left ventricular vortex formation is unaffected by diastolic impairment

Abstract

Normal left ventricular (LV) filling occurs rapidly early in diastole caused by a progressive pressure gradient within the ventricle and with a low left atrial pressure. This normal diastolic function is altered in patients with heart failure. Such impairment of diastolic filling is manifested as an abrupt deceleration of the early filling wave velocity. Although variations within the early filling wave have been observed previously, the underlying hydrodynamic mechanisms are not well understood. Previously, it was proposed that the mitral annulus vortex ring formation time was the total duration of early diastolic filling and provided a measure of the efficiency of diastolic filling. However, we found that the favorable LV pressure difference driving early diastolic filling becomes zero simultaneously with the deceleration of the early filling wave propagation velocity and pinch-off of the LV vortex ring. Thus we calculated the vortex ring formation time using the duration of the early diastolic filling wave from its initiation to the time of the early filling wave propagation velocity deceleration when pinch-off occurs. This formation time does not vary with decreasing intraventricular pressure difference or with degree of diastolic dysfunction. Thus we conclude the vortex ring pinch-off occurs before the completion of early diastole, and its formation time remains invariant to changes of diastolic function.

Comparative numerical study on left ventricular fluid dynamics after dilated cardiomyopathy

“…In fact, the ratio VFT/EF, which removes the influence of EF on the VFT value, presents a non-significant difference between the two groups, meaning that VFT does not provide information incremental to EF in this specific clinical context. These results are similar to those recently reported by Stewart et al (Stewart et al, 2012), in which the VFT was shown not to weigh on overall cardiac function, but in fact just a sign of optimal LV filling.…”

Doppler vortography - Detection and quantification of the vortices in the left ventricle

“…Our quantitative analysis of the anterior and apical vortices by estimating their vorticity could help to improve the assessment of the heart function in the echocardiographic laboratory. The recent research studies have also revealed an emerging clinical interest for characterization of intra-ventricular flow velocities and supported our findings in this research study [1,2,45,46,62,63,85,86,94,132,133]. Rodevand et al…”

Scan–rescan reproducibility of diastolic left ventricular kinetic energy, viscous energy loss and vorticity assessment using 4D flow MRI: analysis in healthy subjects

“…LV vortex quantification parameters, such as vorticity, could be useful in the assessment of LV and RV diastolic (dys-)function [1,8,9,11,12]. In recent studies, vorticity was shown to be a marker of diastolic dysfunction, both in the LV [9] and the RV [8] of patients with pulmonary hypertension.…”

“…Vorticity, the curl of velocity, is a fundamental quantity in fluid mechanics that describes the local spinning rate of fluid particles and can characterize vortex flow [10]. Quantitative vortex parameters, such as vorticity, have been used to assess diastolic (dys) function in several patient groups [8,9,11,12]. Furthermore, in patients with complex congenital intracardiac deformations such as after the Fontan operation, flow collision with remaining septal structures and stagnation of flow through a ventricular septal defect may result in altered EL and vortex formation [13].…”