Analysis of the early transmitral Doppler velocity curve: effect of primary physiologic changes and compensatory preload adjustment

Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114.

Left ventricular filling (as assessed by Doppler echocardiography) has previously been shown to depend in a complex fashion on ventricular diastolic function (compliance and relaxation) as well as other variables, such as atrial pressure and compliance, ventricular systolic function and mitral valve impedance. To study the effect of isolated physiologic alterations on individual Doppler indexes, a mathematic model of mitral flow was analyzed. By varying one physiologic variable at a time, it was shown that mitral velocity acceleration is affected directly by atrial pressure and inversely by the ventricular relaxation time constant, with relatively little impact of chamber compliance. Deceleration rate was directly influenced by mitral valve area, atrial pressure and ventricular systolic dysfunction and inversely affected by atrial and ventricular compliance relations, with little impact of relaxation unless it was so delayed as to be incomplete during deceleration. Peak velocity was directly affected most strongly by initial left atrial pressure, and lowered somewhat by prolonged relaxation, low atrial and ventricular compliance and systolic dysfunction. Strikingly different filling patterns emerged when the primary physiologic alterations were accompanied by simultaneous compensatory changes in atrial pressure designed to maintain stroke volume constant. Low ventricular compliance with preload compensation produced characteristic E waves with very short acceleration and deceleration times and high peak velocity. Thus, mathematic analysis of ventricular filling helps to explain the physical and physiologic basis for the transmitral velocity curve.

This article has been cited by other articles:

				J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]

				Y. Notomi, M. G. Martin-Miklovic, S. J. Oryszak, T. Shiota, D. Deserranno, Z. B. Popovic, M. J. Garcia, N. L. Greenberg, and J. D. Thomas Enhanced Ventricular Untwisting During Exercise: A Mechanistic Manifestation of Elastic Recoil Described by Doppler Tissue Imaging Circulation, May 30, 2006; 113(21): 2524 - 2533. [Abstract] [Full Text] [PDF]

				A. Rovner, N. L. Greenberg, J. D. Thomas, and M. J. Garcia Relationship of diastolic intraventricular pressure gradients and aerobic capacity in patients with diastolic heart failure Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H2081 - H2088. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology Eur. Heart J., June 1, 2005; 26(11): 1115 - 1140. [Full Text] [PDF]

				S. L. Gaynor, H. S. Maniar, S. M. Prasad, P. Steendijk, and M. R. Moon Reservoir and conduit function of right atrium: impact on right ventricular filling and cardiac output Am J Physiol Heart Circ Physiol, May 1, 2005; 288(5): H2140 - H2145. [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]

				P. Marino, G. Faggian, P. Bertolini, A. Mazzucco, and W. C. Little Early mitral deceleration and left atrial stiffness Am J Physiol Heart Circ Physiol, September 1, 2004; 287(3): H1172 - H1178. [Abstract] [Full Text] [PDF]

				K. Jorgensen, E. Houltz, U. Westfelt, F. Nilsson, H. Schersten, and S.-E. Ricksten Effects of Lung Volume Reduction Surgery on Left Ventricular Diastolic Filling and Dimensions in Patients With Severe Emphysema Chest, November 1, 2003; 124(5): 1863 - 1870. [Abstract] [Full Text] [PDF]

				H. S. Maniar, S. M. Prasad, S. L. Gaynor, C. M. Chu, P. Steendijk, and M. R. Moon Impact of pericardial restraint on right atrial mechanics during acute right ventricular pressure load Am J Physiol Heart Circ Physiol, January 1, 2003; 284(1): H350 - H357. [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]

				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]

				T. Levy, G.H. Jenkins, S. Walker, L. Grieve, C. Webb, M.G. Buckley, D.R.J. Singer, and V. Paul Does the mechanism of action of biatrial pacing for atrial fibrillation involve changes in cardiac haemodynamics?: Assessment by Doppler echocardiography and natriuretic peptide measurements Europace, January 1, 2000; 2(2): 127 - 135. [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]

				W. C. Little, M. Ohno, D. W. Kitzman, J. D. Thomas, and C.-P. Cheng Determination of Left Ventricular Chamber Stiffness From the Time for Deceleration of Early Left Ventricular Filling Circulation, October 1, 1995; 92(7): 1933 - 1939. [Abstract] [Full Text]

				K. Yamamoto, T. Masuyama, Y. Doi, J. Naito, T. Mano, H. Kondo, R. Nagano, J. Tanouchi, M. Hori, and T. Kamada Noninvasive Assessment of Left Ventricular Relaxation Using Continuous-Wave Doppler Aortic Regurgitant Velocity Curve : Its Comparative Value to the Mitral Regurgitation Method Circulation, January 1, 1995; 91(1): 192 - 200. [Abstract] [Full Text]