Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study

Abstract

In an effort to determine what clinically useful information regarding left ventricular diastolic function can be inferred noninvasively with pulsed wave Doppler echocardiography, mitral flow velocity patterns and measured variables were correlated with hemodynamic findings in 70 patients: 30 with coronary artery disease, 20 with idiopathic congestive cardiomyopathy, 14 with a restrictive myocardial process and 6 without significant cardiac disease. The effect of sudden changes in hemodynamics on the mitral flow velocity pattern was also investigated in a subgroup of patients who had simultaneous recording of mitral flow velocity and left ventricular pressure before and after left ventriculography. Mitral flow velocity recordings from 30 healthy adults served as a reference group. This analysis suggests that 1) the majority of patients with these cardiac disorders demonstrate abnormal mitral flow velocity patterns or variables; 2) markedly different flow velocity patterns can be seen in patients with impaired left ventricular relaxation; 3) the different mitral patterns appear to relate more to myocardial function and hemodynamic status than to the type of disease process present; 4) certain mitral patterns suggest different filling pressures and rates of early diastolic left ventricular filling; 5) an increase in left atrial pressure can "normalize" an abnormal mitral flow velocity pattern and "mask" a left ventricular relaxation abnormality; and 6) the different patterns appear to represent a dynamic continuum with the potential to change from one to another as a result of disease progression, medical therapy or sudden changes in hemodynamics. It is concluded that, despite the indirect method of estimation and certain limitations, mitral flow velocity recordings have clinical potential in assessing left ventricular diastolic function that merits further investigation.

Maternal cardiac function in fetal growth‐restricted and non‐growth‐restricted small‐for‐gestational age pregnancies

“…An increase in preload can increase the E-wave; however, an increase in afterload may also increase the A-wave 24 . In addition, mitral inflow patterns can be affected by heart rate, phase of respiration and maternal age 13,25 . Therefore, relying on transmitral flow is not sufficient to assess LV diastolic function.…”

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

“…LV systolic functions were determined as well through estimation of ejection fraction, fractional shortening (considered normal if in the range of 26-46%), mean velocity of circumferential fiber shortening (normal values are in the range between 0.88-1.55 cm/s), pre-ejection/LV ejection ratio (considered normal if the results were in the range between 0.27-0.41 according to Hirschfeld et al 1975) and cardiac output index (normal values are in the range of 2.6-4.2 l/min/m 2 according to Hirschfeld et al 1975). Regarding LV diastolic functions, these were determined through estimation of peak flow rate of E wave, A wave and the ratio between them (e/a ratio), where the normal values are in the range of 50-80 cm/s, 35-50 cm/s and 1-2, respectively, according to Appleton et al (1988). The cardiac mass index was also measured in the present study and it is equal to the LV mass/body surface area (g/m 2 ).…”

Echocardiographic evaluation of diastolic heart failure

“…Secondary measurements include mitral A wave duration, A wave VTI, total mitral inflow VTI. Mitral E velocity reflects early diastolic LA‐LV pressure gradient and is affected by preload and LV relaxation 34 while the A‐wave velocity reflects late diastolic LA‐LV pressure gradient and is affected by LV compliance and LA contractile function. E‐wave DT is influenced by LV relaxation, LV diastolic pressures following mitral valve opening and LV compliance.…”