A NEW APPROACH FOR EVALUATION OF LEFT-VENTRICULAR DIASTOLIC FUNCTION - SPATIAL AND TEMPORAL ANALYSIS OF LEFT-VENTRICULAR FILLING FLOW PROPAGATION BY COLOR M-MODE DOPPLER-ECHOCARDIOGRAPHY

Objectives. To evaluate left ventricular diastolic function and differ entiate the pseudonormalized transmitral how pattern from the normal p attern, the propagation of left ventricular early filling how was asse ssed quantitatively using color M-mode Doppler echocardiography. Backg round. Because the propagation of left ventricular early filling flow is disturbed in the left ventricle with impaired relaxation, quantific ation of such alterations should provide useful indexes for the evalua tion of left ventricular diastolic function. Methods. Study subjects w ere classified into three groups according to the ratio of early to la te transmitral flow velocity (EIA ratio) and left ventricular ejection fraction: 29 subjects with an ejection fraction greater than or equal to 60% (control group); 34 with an ejection fraction <60% and EIA rat io <1 (group I); and 25 with ejection fraction <60% and EIA ratio grea ter than or equal to 1 (group II). The propagation of peak early filli ng flow was visualized by changing the first aliasing limit of the col or Doppler signals. The rate of propagation of peak early filling flow velocity was defined as the distance/time ratio between two sampling points: the point of the maximal velocity around the mitral orifice an d the point in the mid-left ventricle at which the velocity decreased to 70% of its initial value, High fidelity manometer tipped measuremen t was performed in 40 randomly selected subjects. Results. The rate of propagation decreased in groups I and II compared with that in the co ntrol group (33.8 +/- 13.8 [mean +/- SD] and 30.0 +/- 8.6 vs. 74.3 +/- 17.4 cm/s, p < 0.001, respectively) and correlated inversely with the time constant of left ventricular isovolumetric relaxation and the mi nimal first derivative of left ventricular pressure (peak negative dP/ dt) (r = 0.82 and r = 0.72, respectively). Conclusions. Spatial and te mporal analysis of filling flow propagation by color M-mode Doppler ec hocardiography was free of pseudonormalization and correlated well wit h the invasive variables of left ventricular relaxation.