The important role of left ventricular relaxation and left atrial pressure in the left ventricular filling velocity profile

Takagi, S.; Yokota, Mitsuhiro; Iwase, Masatsugu; Yoshida, Junshi; Hayashi, Hiroshi; Sotobata, Iwao; Koide, Masafumi; Saito, Hidehiko

doi:10.1016/0002-8703(89)90230-5

Cited by 47 publications

(20 citation statements)

References 19 publications

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“…Related to this was the apparently incongruous finding that although E is strongly related to these two determinants of ESV (contractility and afterload), E is only weakly related to ESV itself (r=-0.633). This suggests that contractility and afterload may be determinants of some other factor affecting E independent of ESV, such as ventricular shape change and torsion.1920 Contrary to other reports, either alone or together, X1 and T1/2 were not significantly related to E. 10,12,21,22 Common among studies identifying X1 as a significant factor contributing to peak early diastolic flow is the Table 2, E was also found to correlate directly with EF, with both of the measured intracardiac pressure gradients TMPapex and MIVP, and with the heights and slopes of both the LA V and LV F waves. E also correlated inversely with LV minimum pressure.…”

Section: Discussionmentioning

confidence: 92%

Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity.

et al. 1992

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Section: Discussionmentioning

confidence: 92%

Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity.

et al. 1992

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“…Several investigators reported that E-wave velocity and the E/A ratio are influenced by left ventricular filling pressure as well as the rate of fall in left ventricular pres sure [3,5,[16][17][18][19]. IRT is affected not only by the rate of fall in left ventricular pressure, but also by left ventricular filling pressure [5,[6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…IRT is affected not only by the rate of fall in left ventricular pressure, but also by left ventricular filling pressure [5,[6][7][8]. It has been reported that high left ventricular filling pressure can mask the abnormality in transmitral flow velocity waveform [3,5] and shorten IRT [5,6]. The presence of mitral regurgitation increases both E-wave velocity and the E/A ratio and shortens IRT mediated by increased left ventricular filling pressure [10,11,20].…”

Section: Discussionmentioning

confidence: 99%

“…It has previously been reported that patients with coro nary artery disease (CAD) have an abnormal Dopplerderived transmitral flow velocity waveform, which is characterized by a decreased ratio between peak filling velocities during early diastole (E) and during atrial con traction (A) [ 1,2], Recently, several investigators reported that the transmitral flow velocity waveform is influenced by left ventricular filling pressure [3,4], Appleton et al [5] have shown that patients with impaired left ventricular relaxation and elevated left ventricular filling pressure have a transmitral flow velocity waveform resembling the normal (E/A ratio > 1 ), which is named 'pseudonormaliza tion'. Left ventricular isovolumic relaxation time (IRT) is also affected by the left ventricular filling pressure, as well as by the rate of decrease in left ventricular pressure [3,[6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…Left ventricular isovolumic relaxation time (IRT) is also affected by the left ventricular filling pressure, as well as by the rate of decrease in left ventricular pressure [3,[6][7][8]. We thus investigated the usefulness of simultaneous evaluations of transmitral flow velocity waveform and IRT to identify 'pseudonormalization' in patients with CAD.…”

Section: Introductionmentioning

confidence: 99%

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Simultaneous Evaluation of the Doppler-DerivedTransmitral Flow Velocity Waveform and Left Ventricular Isovolumic Relaxation Time in Patients with Coronary Artery Disease

et al. 1996

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We studied the usefulness of simultaneous evaluation of the Doppler-derived transmitral flow velocity waveform and left ventricular isovolumic relaxation time (IRT) in patients with coronary artery disease (CAD). Subjects consisted of 26 healthy volunteers, 54 patients with prior myocardial infarction (MI), and 27 patients with CAD but without prior MI. IRT was measured as the time from the beginning of the aortic valve closure sound to the onset of trans-mitral flow. Peak filling velocity during early diastole (E-wave velocity), peak filling velocity during atrial contraction (A-wave velocity), and IRT were compared among the three groups. No significant difference in A-wave velocity was found among these groups. Whereas E-wave velocity was significantly lower and IRT was significantly longer in patients with CAD but without prior MI than in healthy subjects, no significant differences in E-wave velocity or IRT were observed between patients with prior MI and healthy subjects. We then divided the patients with prior MI into two subgroups, one consisting of 45 patients with mean pulmonary capillary wedge pressure (mPCWP) < 16 mm Hg and the other consisting of 9 patients with mPCWP > 16 mm Hg. There was no significant difference in A-wave velocity between the two subgroups and healthy subjects. E-wave velocity was significantly lower in patients with MI and lower mPCWP than in healthy subjects, however, no significant difference in E-wave velocity was found between the patients with MI and higher mPCWP and the healthy subjects. On the other hand, IRT was significantly longer in those with lower mPCWP and significantly shorter in those with higher mPCWP than in healthy subjects. In conclusion, normal transmitral flow velocity waveform with short IRT suggests a ‘pseudonormaΓ pattern due to elevated mPCWP in patients with CAD.

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Changes in left ventricular inflow and pulmonary venous flow velocities during preload alteration in dilated heart

Kiyoshige

Oki

Fukuda

et al. 1996

Clinical Cardiology

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Summary:The aim of the present study was to assess the changes of left ventricular inflow (LVIF) and pulmonary venous flow (PVF) velocities during preload alteration in 30 patients with dilated heart (LV end-diastolic dimension 2 6.0 cm) and impaired LV systolic function (% fractional shortening of the LV I 25%). We performed transesophageal pulsed Doppler echocardiography during lower body negative (LBNP, -40 mmHg) and positive pressure (LBPP, +40 mmHg) in 10 patients with dilated cardiomyopathy, in 20 with old myocardial infarction, and in 22 healthy controls. Eight of the patients showed a pseudonormalization (compliance failure) pattern, and 22 showed a decreased early diastolic wave and compensatorily increased atrial systolic wave (relaxation failure) pattern of LVIF in the control state. Mean pulmonary capillary wedge pressure (PCWP) was greater in the compliance failure group than in the relaxation failure group in the control state. LVIF in 6 of the 22 patients with the relaxation failure pattern changed to the compliance failure pattern during LBPP, and that in 3 of 8 patients in the compliance failure group changed to the relaxation failure pattern during LBNP. The 6 patients with a change from the relaxation failure to the compliance failure pattern showed significantly higher peak diastolic and atrial systolic PVFs during LBPP than in the control state, and significantly higher PCWPs in the control state than the 16 patients with no change in LVIF. These findings suggest that the compliance failure and relaxation failure patterns of LVIF are readily interchangeable in various hemodynamic conditions, and that pattern analysis of LVIF and PVF during preload alteration is useful for understanding the hemodynamic severity and for evaluating preload reduction therapy in the dilated heart.

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The important role of left ventricular relaxation and left atrial pressure in the left ventricular filling velocity profile

Cited by 47 publications

References 19 publications

Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity.

Factors related to end-systolic volume are important determinants of peak early diastolic transmitral flow velocity.

Simultaneous Evaluation of the Doppler-DerivedTransmitral Flow Velocity Waveform and Left Ventricular Isovolumic Relaxation Time in Patients with Coronary Artery Disease

Changes in left ventricular inflow and pulmonary venous flow velocities during preload alteration in dilated heart

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