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Peak negative myocardial velocity gradient in early diastole as a noninvasive indicator of left ventricular diastolic function

Comparison with transmitral flow velocity indices

Yoshito Shimizu, MD^*, Masaaki Uematsu, MD, PhD, Hiromi Shimizu, MD^*, Ko Nakamura, MD^*, Masakazu Yamagishi, MD, PhD, FACC^* and Kunio Miyatake, MD, PhD, FACC^*

^* Cardiology Division of Medicine, National Cardiovascular Center, Suita, Osaka, Japan
Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, Suita, Osaka, Japan

View larger version (44K): [in a new window]   Figure 1 Calculation of peak negative MVG in early diastole. See text for details.

View larger version (50K): [in a new window]   Figure 2 Transmitral flow velocity patterns (top) and MVG curves (bottom) from representative cases of normal (left), HHD (middle) and DCM (right). E and E/A decreased, DcT increased in HHD, but these variables were not apparently altered in DCM as compared with the normal subject. In contrast, peak negative MVG were lower both in HHD and DCM than in the normal subject.

View larger version (46K): [in a new window]   Figure 3 Transmitral flow velocity patterns (top) and MVG curves (bottom) obtained at rest and during passive leg lifting in a representative case of hypertensive heart disease. E significantly increased and E/A apparently normalized, thus transmitral flow velocity pattern changing from an abnormal relaxation pattern to a near normal pattern by leg lifting. In contrast, peak negative MVG was not significantly altered by the maneuver.

View larger version (33K): [in a new window]   Figure 4 Changes in the transmitral flow velocity indices and peak negative MVG by passive leg lifting maneuver. E and E/A significantly increased while DcT shortened by leg lifting. In contrast, peak negative MVG was unaltered by the maneuver. The same directional changes were observed among different groups. Solid circles = normal subjects; open circles = patients with hypertensive heart disease; and solid squares = patients with dilated cardiomyopathy. Lifting = during passive leg lifting. Rest = at rest.

View larger version (42K): [in a new window]   Figure 5 Transmitral flow velocity patterns (top) and MVG curves (bottom) obtained before and after volume reducing therapy in a representative case of hypertensive heart disease presenting congestive heart failure at the initial examination. E and E/A conspicuously decreased and DcT increased, thereby transmitral flow velocity pattern changing from a near normal pattern to an abnormal relaxation pattern. In contrast, peak negative MVG was apparently improved by the therapy.

View larger version (27K): [in a new window]   Figure 6 Changes in the transmitral flow velocity indices and peak negative MVG before and after volume reducing therapy. E and E/A significantly decreased while DcT increased by the therapy. In contrast, peak negative MVG showed a slight but significant improvement.