INTRAVENTRICULAR DISPERSION OF EARLY DIASTOLIC FILLING - A NEW MARKEROF LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION

Mitral flow velocity patterns are frequently ''normalized'' by the alt eration in the loading condition even in the presence of left ventricu lar (LV) diastolic dysfunction. In addition, a simple index, the ratio of mitral peak early diastolic flow velocity to mitral peak flaw velo city at atrial contraction, is not obtainable in patients with atrial fibrillation (Af). Thus these limitations hamper the value of analyzin g the mitral flow velocity pattern in the assessment of abnormal LV di astolic characteristics. This study was designed to elucidate the hypo thesis that peak early diastolic flow velocity decreases progressively from the base to the apex in patients with LV diastolic dysfunction. Regional diastolic flow velocity patterns at 1, 2, or 3 cm from the mi tral tip toward the apex were simultaneously recorded with the mitral flow velocity pattern by using multigate pulsed Doppler echocardiograp hy in 42 subjects with normal LV function (31 normal volunteers and 11 patients with Af only), 17 patients with hypertensive heart disease, and 22 patients with dilated cardiomyopathy. In the normal subjects ea rly diastolic flow velocity at the mitral tip was maintained at the po sitions 1 to 3 cm away from the tip into the LV cavity. In contrast, r egional peak early diastolic flow velocity progressively decreased tow ard the apex in patients with hypertensive heart disease and dilated c ardiomyopathy. These findings were observed even in patients with a no rmalized mitral flow velocity pattern or those with Af. Thus the asses sment of the intraventricular decrease in peak early diastolic flow ve locity may be useful in detecting LV diastolic dysfunction, particular ly in patients with Af or a ''normalized'' mitral flow velocity patter n.