Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans

Department of Medicine, Massachusetts General Hospital, Boston 02114.

To determine the effect of filling pressure on the pattern of left ventricular filling in humans, the mitral flow velocity profile was measured by pulsed wave Doppler echocardiography during right and left heart catheterization in 11 patients before and during nitroglycerin infusion. Nitroglycerin reduced mean arterial pressure from 90 +/- 9 to 80 +/- 11 mm Hg (p less than 0.001) and mean pulmonary capillary wedge pressure from 9 +/- 4 to 4 +/- 2 mm Hg (p less than 0.001). Cardiac output fell from 6.6 +/- 1.5 to 5.5 +/- 1.4 liters/min (p less than 0.001) and heart rate increased from 60 +/- 13 to 65 +/- 14 beats/min (p less than 0.002). The time constant of isovolumic relaxation (TI.) decreased from 51 +/- 9 to 46 +/- 8 ms (p less than 0.01), indicating faster left ventricular relaxation. Nitroglycerin altered the Doppler characteristics of the early filling (E) wave but not those of the atrial contraction (A) wave. Peak velocity of the E wave decreased from 56 +/- 14 to 44 +/- 9 cm/s (p less than 0.001), peak velocity of the A wave did not change and the ratio of peak velocities of the E and A waves decreased from 0.97 +/- 0.33 to 0.77 +/- 0.20 (p less than 0.02). The deceleration of the E wave decreased from 289 +/- 138 to 186 +/- 71 cm/s2 (p less than 0.02). The ratio of velocity-time integral of the A wave to total velocity-time integral (that is, contribution of atrial contraction to total filling) increased from 0.31 +/- 0.09 to 0.36 +/- 0.08 (p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				A. C. Boyd, D. A. B. Richards, T. Marwick, and L. Thomas Atrial strain rate is a sensitive measure of alterations in atrial phasic function in healthy ageing Heart, September 15, 2011; 97(18): 1513 - 1519. [Abstract] [Full Text] [PDF]

				R. Matyal, N. J. Skubas, S. K. Shernan, and F. Mahmood Review Article: Perioperative Assessment of Diastolic Dysfunction Anesth. Analg., September 1, 2011; 113(3): 449 - 472. [Abstract] [Full Text] [PDF]

				M. D. Nelson, L. A. Altamirano-Diaz, S. R. Petersen, D. S. DeLorey, M. K. Stickland, R. B. Thompson, and M. J. Haykowsky Left ventricular systolic and diastolic function during tilt-table positioning and passive heat stress in humans Am J Physiol Heart Circ Physiol, August 1, 2011; 301(2): H599 - H608. [Abstract] [Full Text] [PDF]

				G. G. Blume, C. J. Mcleod, M. E. Barnes, J. B. Seward, P. A. Pellikka, P. M. Bastiansen, and T. S. M. Tsang Left atrial function: physiology, assessment, and clinical implications Eur Heart J Cardiovasc Imaging, June 1, 2011; 12(6): 421 - 430. [Abstract] [Full Text] [PDF]

				A. Vlahovic Stipac, P. Otasevic, Z. B. Popovic, V. Cvorovic, B. Putnikovic, I. Stankovic, and A. N. Neskovic Prognostic significance of contractile reserve assessed by dobutamine-induced changes of Tei index in patients with idiopathic dilated cardiomyopathy Eur Heart J Cardiovasc Imaging, April 1, 2010; 11(3): 264 - 270. [Abstract] [Full Text] [PDF]

				M. Kayikcioglu, M. Tumuklu, M. Ozkahya, O. Ozdogan, G. Asci, S. Duman, H. Toz, L. H. Can, A. Basci, and E. Ok The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis Nephrol. Dial. Transplant., March 1, 2009; 24(3): 956 - 962. [Abstract] [Full Text] [PDF]

				T. A. Abd El-Aziz A-Wave Acceleration: A New Doppler Echocardiographic Index for Evaluation of Left Ventricular Diastolic Dysfunction in Elderly Patients Angiology, August 1, 2008; 59(4): 435 - 441. [Abstract] [PDF]

				A. Drighil, J. E. Madias, J. W. Mathewson, H. El Mosalami, N. El Badaoui, B. Ramdani, and A. Bennis Haemodialysis: effects of acute decrease in preload on tissue Doppler imaging indices of systolic and diastolic function of the left and right ventricles Eur Heart J Cardiovasc Imaging, July 1, 2008; 9(4): 530 - 535. [Abstract] [Full Text] [PDF]

				M. A. Fifer and G. J. Vlahakes Management of Symptoms in Hypertrophic Cardiomyopathy Circulation, January 22, 2008; 117(3): 429 - 439. [Full Text] [PDF]

				L. d. l. Fuentes, A. L. Brown, S. J. Mathews, A. D. Waggoner, P. F. Soto, R. J. Gropler, and V. G. Davila-Roman Metabolic syndrome is associated with abnormal left ventricular diastolic function independent of left ventricular mass Eur. Heart J., March 1, 2007; 28(5): 553 - 559. [Abstract] [Full Text] [PDF]

				H. Solus-Biguenet, M. Fleyfel, B. Tavernier, E. Kipnis, J. Onimus, E. Robin, G. Lebuffe, C. Decoene, F. R. Pruvot, and B. Vallet Non-invasive prediction of fluid responsiveness during major hepatic surgery Br. J. Anaesth., December 1, 2006; 97(6): 808 - 816. [Abstract] [Full Text] [PDF]

				L. Shmuylovich and S. J. Kovacs Load-independent index of diastolic filling: model-based derivation with in vivo validation in control and diastolic dysfunction subjects J Appl Physiol, July 1, 2006; 101(1): 92 - 101. [Abstract] [Full Text] [PDF]

				E. H. Y. Ie and R. Zietse Evaluation of cardiac function in the dialysis patient--a primer for the non-expert Nephrol. Dial. Transplant., June 1, 2006; 21(6): 1474 - 1481. [Full Text] [PDF]

				T. G. Neilan, D. M. Yoerger, P. S. Douglas, J. E. Marshall, E. F. Halpern, D. Lawlor, M. H. Picard, and M. J. Wood Persistent and reversible cardiac dysfunction among amateur marathon runners Eur. Heart J., May 1, 2006; 27(9): 1079 - 1084. [Abstract] [Full Text] [PDF]

				M. C. C. Borges, R. C.R. Colombo, J. G. F. Goncalves, J. d. O. Ferreira, and K. G. Franchini Longitudinal Mitral Annulus Velocities Are Reduced in Hypertensive Subjects With or Without Left Ventricle Hypertrophy Hypertension, May 1, 2006; 47(5): 854 - 860. [Abstract] [Full Text] [PDF]

				M. Mestan, A. Babu, and J. Kvasnicka The influence of fluid and diuretic administration on the index of atrial contribution in sequentially paced patients. Europace, April 1, 2006; 8(4): 273 - 278. [Abstract] [Full Text] [PDF]

				A. Eerola, E. Jokinen, T. Boldt, and J. Pihkala The Influence of Percutaneous Closure of Patent Ductus Arteriosus on Left Ventricular Size and Function: A Prospective Study Using Two- and Three-Dimensional Echocardiography and Measurements of Serum Natriuretic Peptides J. Am. Coll. Cardiol., March 7, 2006; 47(5): 1060 - 1066. [Abstract] [Full Text] [PDF]

				J.-W. Ha, J.-R. Cho, J.-M. Kim, J.-A. Ahn, E.-Y. Choi, S.-M. Kang, S.-J. Rim, and N. Chung Tissue Doppler-Derived Indices Predict Exercise Capacity in Patients With Apical Hypertrophic Cardiomyopathy Chest, November 1, 2005; 128(5): 3428 - 3433. [Abstract] [Full Text] [PDF]

				L. Groban and S. Y. Dolinski Transesophageal Echocardiographic Evaluation of Diastolic Function Chest, November 1, 2005; 128(5): 3652 - 3663. [Abstract] [Full Text] [PDF]

				M. Filipovic, J. Wang, I. Michaux, P. Hunziker, K. Skarvan, and M. D. Seeberger Effects of halothane, sevoflurane and propofol on left ventricular diastolic function in humans during spontaneous and mechanical ventilation Br. J. Anaesth., February 1, 2005; 94(2): 186 - 192. [Abstract] [Full Text] [PDF]

				N Wisniacki, W Taylor, M Lye, and J P H Wilding Insulin resistance and inflammatory activation in older patients with systolic and diastolic heart failure Heart, January 1, 2005; 91(1): 32 - 37. [Abstract] [Full Text] [PDF]

				B. W.L. De Boeck, J. K. Oh, P. M. Vandervoort, J. A. Vierendeels, R. P.L.M. van der Aa, and M.-J. M. Cramer Colour M-mode velocity propagation: a glance at intra-ventricular pressure gradients and early diastolic ventricular performance Eur J Heart Fail, January 1, 2005; 7(1): 19 - 28. [Abstract] [Full Text] [PDF]

				T. E. Meyer, M. Karamanoglu, A. A. Ehsani, and S. J. Kovacs Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction J Appl Physiol, November 1, 2004; 97(5): 1667 - 1672. [Abstract] [Full Text] [PDF]

				M. S. Maurer, D. Spevack, D. Burkhoff, and I. Kronzon Diastolic dysfunction: Can it be diagnosed by Doppler echocardiography? J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1543 - 1549. [Abstract] [Full Text] [PDF]

				H. I. Karvounis, C. E. Papadopoulos, T. A. Zaglavara, I. G. Nouskas, K. D. Gemitzis, G. E. Parharidis, and G. E. Louridas Evidence of Left Ventricular Dysfunction in Asymptomatic Elderly Patients with Non-insulin-dependent Diabetes Mellitus Angiology, September 1, 2004; 55(5): 549 - 555. [Abstract] [PDF]

				H. I. Karvounis, I. G. Nouskas, T. M. Farmakis, K. M. Vrogistinos, C. E. Papadopoulos, T. A. Zaglavara, G. E. Parharidis, and G. E. Louridas Evaluation of a Doppler-Derived Index Combining Systolic and Diastolic Left Ventricular Function in Acute Myocardial Infarction Angiology, January 1, 2004; 55(1): 21 - 28. [Abstract] [PDF]

				J. C. Baldi, K. McFarlane, H. C. Oxenham, G. A. Whalley, H. J. Walsh, and R. N. Doughty Left ventricular diastolic filling and systolic function of young and older trained and untrained men J Appl Physiol, December 1, 2003; 95(6): 2570 - 2575. [Abstract] [Full Text]

				L. Thomas, A. Boyd, S. P. Thomas, N. B. Schiller, and D. L. Ross Atrial structural remodelling and restoration of atrial contraction after linear ablation for atrial fibrillation Eur. Heart J., November 1, 2003; 24(21): 1942 - 1951. [Abstract] [Full Text] [PDF]

				E. H.Y. Ie, W. B. Vletter, F. J. ten Cate, R. W. Nette, W. Weimar, J. R.T.C. Roelandt, and R. Zietse Preload Dependence of New Doppler Techniques Limits Their Utility for Left Ventricular Diastolic Function Assessment in Hemodialysis Patients J. Am. Soc. Nephrol., July 1, 2003; 14(7): 1858 - 1862. [Abstract] [Full Text] [PDF]

				T. M. Koelling, G. W. Dec, L. C. Ginns, and M. J. Semigran Left Ventricular Diastolic Function in Patients With Advanced Cystic Fibrosis Chest, May 1, 2003; 123(5): 1488 - 1494. [Abstract] [Full Text] [PDF]

				G. N. Djaiani, B. J. McCreath, L. K. Ti, B. G. Mackensen, M. Podgoreanu, B. Phillips-Bute, and J. P. Mathew Mitral Flow Propagation Velocity Identifies Patients with Abnormal Diastolic Function During Coronary Artery Bypass Graft Surgery Anesth. Analg., September 1, 2002; 95(3): 524 - 530. [Abstract] [Full Text] [PDF]

				J. Koyama, P. A. Ray-Sequin, and R. H. Falk Prognostic Significance of Ultrasound Myocardial Tissue Characterization in Patients With Cardiac Amyloidosis Circulation, July 30, 2002; 106(5): 556 - 561. [Abstract] [Full Text] [PDF]

				F. Prunier, R. Gaertner, L. Louedec, J.-B. Michel, J.-J. Mercadier, and B. Escoubet Doppler echocardiographic estimation of left ventricular end-diastolic pressure after MI in rats Am J Physiol Heart Circ Physiol, July 1, 2002; 283(1): H346 - H352. [Abstract] [Full Text] [PDF]

				G. A. Whalley, R. N. Doughty, G. D. Gamble, S. P. Wright, H. J. Walsh, S. A. Muncaster, and N. Sharpe Pseudonormal mitral filling pattern predicts hospital re-admission in patients with congestive heart failure J. Am. Coll. Cardiol., June 5, 2002; 39(11): 1787 - 1795. [Abstract] [Full Text] [PDF]

				F Yalcin, A Kaftan, H Muderrisoglu, M E Korkmaz, F Flachskampf, M Garcia, and J D Thomas Is Doppler tissue velocity during early left ventricular filling preload independent? Heart, April 1, 2002; 87(4): 336 - 339. [Abstract] [Full Text] [PDF]

				M. Galderisi, G. Vitale, G. Lupoli, M. Barbieri, G. Varricchio, C. Carella, O. de Divitiis, and G. Paolisso Inverse Association Between Free Insulin-Like Growth Factor-1 and Isovolumic Relaxation in Arterial Systemic Hypertension Hypertension, October 1, 2001; 38(4): 840 - 845. [Abstract] [Full Text] [PDF]

				T. J. Kolias, K. D. Aaronson, and W. F. Armstrong Doppler-derived dP/dt and -dP/dt predict survival in congestive heart failure J. Am. Coll. Cardiol., November 1, 2000; 36(5): 1594 - 1599. [Abstract] [Full Text] [PDF]

				S. R. Ommen, R. A. Nishimura, C. P. Appleton, F. A. Miller, J. K. Oh, M. M. Redfield, and A. J. Tajik Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures : A Comparative Simultaneous Doppler-Catheterization Study Circulation, October 10, 2000; 102(15): 1788 - 1794. [Abstract] [Full Text] [PDF]

				F. L. Dini, C. Michelassi, G. Micheli, and D. Rovai Prognostic value of pulmonary venous flow Doppler signal in left ventricular dysfunction: contribution of the difference in duration of pulmonary venous and mitral flow at atrial contraction J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1295 - 1302. [Abstract] [Full Text] [PDF]

				J. E. Moller, E. Sondergaard, J. B. Seward, C. P. Appleton, and K. Egstrup Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: Prognostic and clinical implications J. Am. Coll. Cardiol., February 1, 2000; 35(2): 363 - 370. [Abstract] [Full Text] [PDF]

				M. J. Garcia, N. G. Smedira, N. L. Greenberg, M. Main, M. S. Firstenberg, J. Odabashian, and J. D. Thomas Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation J. Am. Coll. Cardiol., January 1, 2000; 35(1): 201 - 208. [Abstract] [Full Text] [PDF]

				S. Nakatani, M. J. Garcia, M. S. Firstenberg, L. Rodriguez, R. A. Grimm, N. L. Greenberg, P. M. McCarthy, P. M. Vandervoort, and J. D. Thomas Noninvasive assessment of left atrial maximum dP/dt by a combination of transmitral and pulmonary venous flow J. Am. Coll. Cardiol., September 1, 1999; 34(3): 795 - 801. [Abstract] [Full Text] [PDF]

				M.B. Tiras, R. Yalcin, V. Noyan, I. Maral, M. Yildirim, O. Dortlemez, and S. Daya Alterations in cardiac flow parameters in patients with polycystic ovarian syndrome Hum. Reprod., August 1, 1999; 14(8): 1949 - 1952. [Abstract] [Full Text] [PDF]

				T. Tanaka, K. Mizushige, H. Masugata, H. Matsuo, and K. Mizushige Prolongation of Left Atrial Augmentation After Handgrip Stress in Coronary Artery Disease: Observation Using Pulsed Doppler Flowmetry Angiology, April 1, 1999; 50(4): 299 - 308. [Abstract] [PDF]

				S. B. Solomon, P. Barbier, and S. A. Glantz Changes in porcine transmitral flow velocity pattern and its diastolic determinants during partial coronary occlusion J. Am. Coll. Cardiol., March 1, 1999; 33(3): 854 - 866. [Abstract] [Full Text] [PDF]

				S. F. Nagueh, I. Mikati, H. A. Kopelen, K. J. Middleton, M. A. Quinones, and W. A. Zoghbi Doppler Estimation of Left Ventricular Filling Pressure in Sinus Tachycardia : A New Application of Tissue Doppler Imaging Circulation, October 20, 1998; 98(16): 1644 - 1650. [Abstract] [Full Text] [PDF]

				K. Mizushige, H. Masugata, H. Morita, S. Senda, H. Matsuo, and K. Mizushige Left Ventricular Diastolic Filling Dynamics During Isometric Exertion in Syndrome X Assessed with Doppler Flowmetry Angiology, October 1, 1997; 48(10): 871 - 881. [Abstract] [PDF]

				S. J. Kovacs, J. Rosado, A. L. M. McGuire, and A. F. Hall Can Transmitral Doppler E-Waves Differentiate Hypertensive Hearts From Normal? Hypertension, October 1, 1997; 30(4): 788 - 795. [Abstract] [Full Text]

				L. E. Shapiro, R. Sievert, L. Ong, E. L. Ocampo, R. A. Chance, M. Lee, M. Nanna, K. Ferrick, and M. I. Surks Minimal Cardiac Effects in Asymptomatic Athyreotic Patients Chronically Treated with Thyrotropin-Suppressive Doses of L-Thyroxine J. Clin. Endocrinol. Metab., August 1, 1997; 82(8): 2592 - 2595. [Abstract] [Full Text] [PDF]

				M. Courtois, B. Barzilai, A. F Hall, and P. A Ludbrook Postextrasystolic left ventricular isovolumic pressure decay is not monoexponential Cardiovasc Res, August 1, 1997; 35(2): 206 - 216. [Abstract] [Full Text] [PDF]

				M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]

				S. F. Nagueh, H. A. Kopelen, and M. A. Quinones Assessment of Left Ventricular Filling Pressures by Doppler in the Presence of Atrial Fibrillation Circulation, November 1, 1996; 94(9): 2138 - 2145. [Abstract] [Full Text]

				M. E. Tavel Cardiac Auscultation : A Glorious Past But Does It Have a Future? Circulation, March 15, 1996; 93(6): 1250 - 1253. [Full Text]

				J. R. Petersen, H. Drabaek, G. Gleerup, J. Mehlsen, L. Juhl Petersen, and K. Winther ACE Inhibition with Spirapril Improves Diastolic Function at Rest Independent of Vasodilation During Treatment with Spirapril in Mild to Moderate Hypertension Angiology, March 1, 1996; 47(3): 233 - 240. [Abstract] [PDF]

				R. Nagano, T. Masuyama, M. Naka, M. Hori, and T. Kamada Contribution of Atrial Reservoir Function to Ventricular Filling in Hypertensive Patients : Effects of Nifedipine Administration Hypertension, November 1, 1995; 26(5): 815 - 819. [Abstract] [Full Text]

				J. L. Fleg, E. P. Shapiro, F. O'Connor, J. Taube, A. P. Goldberg, and E. G. Lakatta Left Ventricular Diastolic Filling Performance in Older Male Athletes JAMA, May 3, 1995; 273(17): 1371 - 1375. [Abstract] [PDF]

				P. Spirito and B. J. Maron Doppler Echocardiography for Assessing Left Ventricular Diastolic Function Ann Intern Med, July 15, 1988; 109(2): 122 - 126. [Abstract] [PDF]