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CLINICAL STUDIES

Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation

^a Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
^b Department of Cardiothoracic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received March 25, 1999; revised manuscript received July 22, 1999, accepted September 21, 1999.

Reprint requests and correspondence: Dr. Mario J. Garcia, Desk F-15, Division of Cardiology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195.
garciam{at}ccf.org

OBJECTIVES

To determine the effect of preload in color M-mode Doppler flow propagation velocity (v_p).

BACKGROUND

The interpretation of Doppler filling patterns is limited by confounding effects of left ventricular (LV) relaxation and preload. Color M-mode v_p has been proposed as a new index of LV relaxation.

METHODS

We studied four dogs before and during inferior caval (IVC) occlusion at five different inotropic stages and 14 patients before and during partial cardiopulmonary bypass. Left ventricular (LV) end-diastolic volumes (LV-EDV), the time constant of isovolumic relaxation (tau), left atrial (LA) pre-A and LV end-diastolic pressures (LV-EDP) were measured. Peak velocity during early filling (E) and v_p were extracted by digital analysis of color M-mode Doppler images.

RESULTS

In both animals and humans, LV-EDV and LV-EDP decreased significantly from baseline to IVC occlusion (both p < 0.001). Peak early filling (E) velocity decreased in animals from 56 ± 21 to 42 ± 17 cm/s (p < 0.001) without change in v_p (from 35 ± 15 to 35 ± 16, p = 0.99). Results were similar in humans (from 69 ± 15 to 53 ± 22 cm/s, p < 0.001, and 37 ± 12 to 34 ± 16, p = 0.30). In both species, there was a strong correlation between LV relaxation (tau) and v_p (r = 0.78, p < 0.001, r = 0.86, p < 0.001).

CONCLUSIONS

Our results indicate that color M-mode Doppler v_p is not affected by preload alterations and confirms that LV relaxation is its main physiologic determinant in both animals during varying lusitropic conditions and in humans with heart disease.

Abbreviations and Acronyms   A = peak atrial contraction velocity   E = peak early transmitral flow velocity   IVC = inferior vena cava   LA = left atrium   LV = left ventricle or ventricular   LV-EDP = left ventricular end-diastolic pressure   LV-EDV = left ventricular end-diastolic volume   LV-EF = left ventricular ejection fraction   LV-ESP = left ventricular end-systolic pressure   LV-ESV = left ventricular end-systolic volume   tau = time constant of isovolumic relaxation   TD = time delay   TEE = transesophageal echocardiography   vp = color M-mode flow propagation velocity

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