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J Am Coll Cardiol, 1992; 19:998-1004 © 1992 by the American College of Cardiology Foundation |
Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston.
The quantitative assessment of ventricular diastolic function is an important goal of Doppler echocardiography. Hydrodynamic analysis predicts that the net compliance (Cn) of the left atrium and ventricle can be quantitatively predicted from the deceleration rate (dv/dt) of the mitral velocity profile by the simple expression: Cn = - A/rho dv/dt, where A is effective mitral valve area and rho is blood density. This formula was validated using an in vitro model of transmitral filling where mitral valve area ranged from 0.5 to 2.5 cm2 and net compliance from 0.012 to 0.023 cm3/(dynes/cm2) (15 to 30 cm3/mm Hg). In 34 experiments in which compliance was held constant throughout the filling period, net atrioventricular compliance was accurately calculated from the E wave downslope and mitral valve area (r = 0.95, p less than 0.0001). In a second group of experiments, chamber compliance was allowed to vary as a function of chamber pressure. When net compliance decreased during diastole (as when the ventricle moved to a steeper portion of its pressure-volume curve), the transorifice velocity profile was concave downward, whereas when net compliance increased, the velocity profile was concave upward. Application of the preceding formula to these curved profiles allowed instantaneous compliance to be calculated throughout the filling period (r = 0.93, p less than 0.001). Numeric application of a mathematic model of mitral filling demonstrated the accuracy of this approach in both restrictive and nonrestrictive orifices.(ABSTRACT TRUNCATED AT 250 WORDS)
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