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

Division of Cardiology, Stanford University School of Medicine, California.

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.

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				L. Cabanes, B. Richaud-Thiriez, Y. Fulla, F. Heloire, C. Vuillemard, S. Weber, and D. Dusser Brain Natriuretic Peptide Blood Levels in the Differential Diagnosis of Dyspnea Chest, December 1, 2001; 120(6): 2047 - 2050. [Abstract] [Full Text] [PDF]

				S. Capomolla, G. Pinna, O. Febo, A. Caporotondi, G. Guazzotti, M. T. La Rovere, M. Gnemmi, A. Mortara, R. Maestri, and F. Cobelli Echo-Doppler mitral flow monitoring: an operative tool to evaluate day-to-day tolerance to and effectiveness of beta-adrenergic blocking agent therapy in patients with chronic heart failure J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1675 - 1684. [Abstract] [Full Text] [PDF]

				C-M Yu, B M Y Cheung, R Leung, Q Wang, W-H Lai, and C-P Lau Increase in plasma adrenomedullin in patients with heart failure characterised by diastolic dysfunction Heart, August 1, 2001; 86(2): 155 - 160. [Abstract] [Full Text] [PDF]

				T. D. Kinnaird, C. R. Thompson, and B. I. Munt The deceleration time of pulmonary venous diastolic flow is more accurate than the pulmonary artery occlusion pressure in predicting left atrial pressure J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2025 - 2030. [Abstract] [Full Text] [PDF]

				F. Scapellato, P. L. Temporelli, E. Eleuteri, U. Corra, A. Imparato, and P. Giannuzzi Accurate noninvasive estimation of pulmonary vascular resistance by Doppler echocardiography in patients with chronic heart failure J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1813 - 1819. [Abstract] [Full Text] [PDF]

				H. Valensise, G. P. Novelli, B. Vasapollo, G. Di Ruzza, M. E. Romanini, M. Marchei, G. Larciprete, D. Manfellotto, C. Romanini, and A. Galante Maternal Diastolic Dysfunction and Left Ventricular Geometry in Gestational Hypertension Hypertension, May 1, 2001; 37(5): 1209 - 1215. [Abstract] [Full Text] [PDF]