REPRODUCIBILITY OF DOPPLER INDEXES OF LEFT-VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN PATIENTS WITH SEVERE CHRONIC HEART-FAILURE

Doppler ultrasound has been utilized to evaluate cardiac output and le ft ventricular filling pressure in patients with various cardiac disea ses. This method would be particularly useful for non-invasive haemody namic monitoring in patients with severe chronic heart failure. Howeve r, few data exist on the reproducibility of Doppler indices in this po pulation. To determine the magnitude of technical and biological varia bility of Doppler indices, serial Doppler echocardiographic studies we re performed in 26 patients with severe heart failure in the usual cli nical setting. Short-term intra- and inter-observer, mid-term and day- to-day variabilities of stroke volume, cardiac output, maximal early a nd late diastolic velocities of mitral flow, rate of decrease and dece leration time of flow velocity in early diastole and the colour Dopple r area of the mitral regurgitant jet were evaluated by two cardiologis ts. For each source of variability, correlation coefficients with stan dard errors and mean differences between paired determinations with th eir standard deviations were calculated. Short-term (intra- and inter- observer) variability was small for each considered variable: the mean differences of measurements were within 10% of the mean value for mos t parameters and no systematic error was found. Stroke volume and card iac output showed a significant increase in the afternoon. The standar d deviations of differences between day-to-day measurements were 4.1 m l (9% of the mean value) and 39 ml (11% of the mean value), respective ly. Doppler indices assessing diastolic filling and colour Doppler are a of mitral regurgitant jet showed greater variations on a mid-term an d day-to-day basis. 'Spontaneous' shifts from a predominant early dias tolic velocity to a predominant late diastolic velocity mitral flow pa ttern were observed in four patients with coronary artery disease and less compromised left ventricular ejection fraction. We conclude that, in patients with severe heart failure, Doppler measurements have a go od short-term intra- and inter-observer reproducibility and, therefore , may be suitable for assessing acute interventions. For systolic indi ces, day-to-day variability was also fairly small, provided that a rig orous-but practicably obtainable-methodology is used. The relatively l arge mid-term and day-to-day variability of diastolic variables, obser ved in less compromised patients, should be considered when serial Dop pler studies are performed.