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CLINICAL RESEARCH: DOPPLER ASSESSMENT OF LV FUNCTION

Noninvasive assessment of ejection intraventricular pressure gradients

Raquel Yotti, MD^*, Javier Bermejo, MD, PhD^*,*, J. Carlos Antoranz, PhD, José Luis Rojo-Álvarez, MEng, PhD, Carmen Allue, RDNS^*, Jacobo Silva, MD, M. Mar Desco, MD^||, Mar Moreno, MD^* and Miguel A. García-Fernández, MD^*

^* Department of Cardiology, Madrid, Spain
Department of Cardiovascular Surgery, Madrid, Spain
^|| Unit of Experimental Medicine and Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Spain

Manuscript received May 20, 2003; revised manuscript received August 14, 2003, accepted September 29, 2003.

^* Reprint requests and correspondence: Dr. Javier Bermejo, Laboratory of Echocardiography, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007 Madrid, Spain.
javbermejo{at}jet.es

OBJECTIVES: The study was designed to validate in vivo a new method to measure ejection intraventricular pressure gradients (IVPGs) by processing color M-mode Doppler data and to assess the effects of inotropic interventions on IVPGs in the clinical setting.

BACKGROUND: In the absence of obstruction, ejection IVPGs cannot be estimated by Doppler using the simplified Bernoulli equation.

METHODS: High-fidelity micromanometers were placed in the left ventricle of eight minipigs, and synchronic Doppler images and pressure signals were obtained during different hemodynamic conditions. Twenty healthy volunteers and 20 dilated cardiomyopathy patients were studied at baseline and during esmolol, dobutamine, and atropine infusion (only dobutamine in patients).

RESULTS: Excellent agreement was observed between micromanometer and Doppler methods for measuring instantaneous pressure differences among the apex, the mid-cavity, and the outflow tract (R_intraclass = 0.98, 0.81, 0.76, and 0.98 for the peak, time-to-peak, peak reverse, and time-to-peak reverse values, respectively; n = 810 beats). Error of the noninvasive method was –0.05 ± 0.25 mm Hg for the peak pressure difference. Parametrical images demonstrated that IVPGs originate mainly in the mid-ventricle and then propagate to the outflow tract. Both the magnitude and the temporal course of IVPGs were different among volunteers and patients. Inotropic interventions induced significant changes in the apex-outflow tract pressure differences in both populations, whereas atropine had no effect on IVPGs.

CONCLUSIONS: For the first time, ejection IVPGs can be accurately visualized and measured by Doppler-echocardiography. Important aspects of the dynamic interaction among myocardial performance, load mechanics, and ejection dynamics can be assessed in the clinical setting using this method.

Abbreviations and Acronyms   P = ejection intraventricular pressure difference   DCM = dilated cardiomyopathy   ECG = electrocardiogram/electrocardiographic   IVPG = intraventricular pressure gradient   LV = left ventricle/ventricular   LVOT = left ventricular outflow tract   Rintraclass = intraclass correlation coefficient

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