Supplemental Figures and Videos

Supplemental Figures and Videos

Files in this Data Supplement:

• View Supplemental Figures - Supplemental Figures
• View Video 1 - Video 1. Left ventricular (LV) flow sequence on Doppler and contrast echocardiography. Flow Doppler (left) is compared with high-temporal resolution contrast echocardiography (right, 250 frames/s) in apical long-axis view of the LV. Note the vortices and the characteristics of intracavitary flow orthogonal to the direction of the ultrasound beam. Ao = aorta; IVR = isovolumic relaxation; LA = left atrium; LVOT = left ventricular outflow tract.
• View Video 2 - Video 2. Quantitative assessment of flow sequence using particle image velocimetry. The movement of contrast bubbles (left) is mapped by particle image velocimetry (right). Intraventricular flow sequence during the transition from diastole to systole and vice versa changes without any phase of hemodynamic stasis. Ao = aorta; LA = left atrium; LV = left ventricular; LVOT = left ventricular outflow tract.
• View Video 3 - Video 3. Intracavitary flow during the pre-ejection period. Pre-ejection movement of contrast bubbles (left) has been tracked with particle imaging velocimetry (right). Note that the apex-to-base redirection of blood flow merges with a vortex formed across the edge of a closing anterior mitral leaflet. The apex-to-base movement of intracavitary flow continues further during the period between mitral valve closure and aortic valve opening (isovolumic contraction). Ao = aorta; LA = left atrium; LV = left ventricular.
• View Video 4 - Video 4. Comparison of pre-ejection flow during sinus rhythm and epicardial pacing. Left ventricular (LV) pre-ejection flow is shown during sinus rhythm (left; heart rate: 72 beats/min) and epicardial pacing (right; heart rate: 82 beats/min). The redirection of contrast bubbles is well coordinated during normal electrical activation (left). During epicardial pacing, despite a shorter cardiac cycle length, the duration of the pre-ejection period is prolonged. Pacing from the LV epicardial surface near the base produces turbulence and a delay in closure of the mitral valve. Both right and left image sequences were recorded at 250 frames/s and are displayed at the same speed. LA = left atrium.
• View Video 5 - Video 5. Sequence of pre-ejection flow during epicardial pacing. Delayed left ventricular (LV) pre-ejection flow sequence by contrast echocardiography during epicardial pacing (left; also shown in Video 4) is mapped by particle image velocimetry (right). The LV epicardial surface has been electrically stimulated near the base. Note the initial base-to-apex direction of flow with turbulence and a delay in apex-to-base redirection. Ao = aorta; LA = left atrium.