Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation
Experimental studies and clinical application
Carlos Rivas-Gotz, MD*,
Dirar S. Khoury, PhD*,
Michael Manolios, MD*,
Liyun Rao, PhD*,
Helen A. Kopelen, RDCS* and
Sherif F. Nagueh, MD*,*
* Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Figure 1 Mitral inflow and pulse wave tissue Doppler (TD) of the mitral annulus before and after constriction of the circumflex coronary artery (Cx). Notice the reduced velocity of Ea and its delayed onset with respect to onset of mitral E after the intervention. A = transmitral late diastolic velocity; E = transmitral early diastolic velocity.
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Figure 2 Regression plots between the average time interval between onset of Ea and onset of mitral inflow (TEa-E) and tau (left) and left ventricular (LV) minimal pressure (right).
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Figure 3 Mitral and tissue Doppler (TD) recordings of the mitral annulus from a normal, an impaired relaxation (IR), and pseudonormal (PN) patients. Notice the later onset of Ea with respect to onset of mitral E in the IR and PN patients.
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Figure 4 Regression plot of pulmonary capillary wedge pressure (PCWP) by right heart catheterization (Cath.) versus PCWP by Doppler in the initial group of 60 patients. Patients with normal relaxation are shown in black circles, those with impaired relaxation in white circles, and those with pseudonormal filling in black squares.
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Figure 5 Regression plot between pulmonary capillary wedge pressure (PCWP) by catheter versus PCWP by Doppler (left) and the Bland Altman plot (right). The middle line refers to the mean difference, and the upper and lower lines correspond to mean + 2 SD and mean – 2 SD, respectively.
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Figure 6 Regression plot between pulmonary capillary wedge pressure (PCWP) by catheter versus the dimensionless ratio of isovolumetric relaxation time (IVRT)/TEa-E in all 93 patients. The dashed line is the regression plot line. The vertical line marks the IVRT/TEa-E cutoff of 2, and the horizontal line marks the PCWP cutoff of 15.
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