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CLINICAL STUDY

Left ventricular outflow tract mean systolic acceleration as a surrogatefor the slope of the left ventricular end-systolic pressure-volume relationship

Fabrice Bauer, MD^*, Michael Jones, MD, Takahiro Shiota, MD, FACC^*,*, Michael S. Firstenberg, MD^*, Jian Xin Qin, MD^*, Hiroyuki Tsujino, BSc^*, Yong Jin Kim, MD^*, Marta Sitges, MD^*, Lisa A. Cardon, RDCS^*, Arthur D. Zetts and James D. Thomas, MD, FACC^*

^* Cleveland Clinic Foundation, Cleveland, Ohio, USA
National Heart, Lung, and Blood Institute of Health, Bethesda, Maryland, USA

Manuscript received November 8, 2001; revised manuscript received May 6, 2002, accepted June 27, 2002.

^* Reprint requests and correspondence: Dr. Takahiro Shiota, Department of Cardiology, Desk F15, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
Shiotat{at}ccf.org

OBJECTIVES: The goal of this study was to analyze left ventricular outflow tract systolic acceleration (LVOT_Acc) during alterations in left ventricular (LV) contractility and LV filling.

BACKGROUND: Most indexes described to quantify LV systolic function, such as LV ejection fraction and cardiac output, are dependent on loading conditions.

METHODS: In 18 sheep (4 normal, 6 with aortic regurgitation, and 8 with old myocardial infarction), blood flow velocities through the LVOT were recorded using conventional pulsed Doppler. The LVOT_Acc was calculated as the aortic peak velocity divided by the time to peak flow; LVOT_Acc was compared with LV maximal elastance (E_m) acquired by conductance catheter under different loading conditions, including volume and pressure overload during an acute coronary occlusion (n = 10). In addition, a clinically validated lumped-parameter numerical model of the cardiovascular system was used to support our findings.

RESULTS: Left ventricular E_m and LVOT_Acc decreased during ischemia (1.67 ± 0.67 mm Hg·ml^–1 before vs. 0.93 ± 0.41 mm Hg·ml^–1 during acute coronary occlusion [p < 0.05] and 7.9 ± 3.1 m·s^–2 before vs. 4.4 ± 1.0 m·s^–2 during coronary occlusion [p < 0.05], respectively). Left ventricular outflow tract systolic acceleration showed a strong linear correlation with LV E_m (y = 3.84x + 1.87, r = 0.85, p < 0.001). Similar findings were obtained with the numerical modeling, which demonstrated a strong correlation between predicted and actual LV E_m (predicted = 0.98 [actual] –0.01, r = 0.86). By analysis of variance, there was no statistically significant difference in LVOT_Acc under different loading conditions.

CONCLUSIONS: For a variety of hemodynamic conditions, LVOT_Acc was linearly related to the LV contractility index LV E_m and was independent of loading conditions. These findings were consistent with numerical modeling. Thus, this Doppler index may serve as a good noninvasive index of LV contractility.

Abbreviations and Acronyms   ANOVA   analysis of variance   EF   ejection fraction   Em   maximal elastance   LV   left ventricle/ventricular   LVOT   left ventricular outflow tract   LVOTAcc   left ventricular outflow tract systolic acceleration   MI   myocardial infarction   PV   peak aortic flow velocity   t-PV   time to peak velocity   t-PVcor   the heart rate-corrected time of time to peak velocity

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