PISTON ENGINE AND PADDLE WHEEL HEART - COLOR-CODED DOPPLER VENTRICULOGRAPHY IN PRIMARY MYOCARDIAL-DISEASE WITH GOOD AND POOR PUMP FUNCTION

The aim was to study color-coded Doppler ventriculography in patients with good and poor left ventricular function. Patients in group 1 (n = 10) had angina pectoris or inferior infarction and slightly impaired left ventricular function (median calculated ejection fraction 0.54). Patients in group 2 (n = 10) had considerably reduced pump function on the basis of anterior infarction or diffuse myocardial disease (media n ejection fraction 0.30). Doppler ventriculography showed a red-coded area in the inferolateral compartment in diastole and a blue-coded ar ea in the anteroseptal compartment in systole. At the time of maximum size of these main-flow areas, smaller reverse-flow areas were seen in the opposite compartments. Blinded analysis demonstrated a higher rev erse-flow/main-flow area ratio in group 2 [0.53 (0.21-0.85)] than in g roup 1 [0.30 (0.10-0.41); p < 0.05]. Continuous blood flow from the in flow to the outflow compartment was observed at the apex throughout th e heart cycle in 7 of the 10 group 2 patients, but not in any of the p atients in group 1 (p < 0.05). Apical thrombi were seen only in the se tting of continuously circulating blood flow and appeared in 3 of the 7 patients. Aneurysms contained separate flow compartments. A statisti cally significant correlation between the two-dimensional echocardiogr aphic image quality and the maximum color-coded area fraction of the v entricle was found. It is, therefore, concluded that Doppler ventricul ography did not improve the overall delineation of the cavity. However , color Doppler imaging revealed a continuously swirling paddle wheel flow in the left ventricle in 70% of patients with poor pump function. In patients with slightly reduced left ventricular function, the Dopp ler ventriculographic flow pattern resembled the abrupt bidirectional blood flow observed in the normal heart. This flow pattern may be comp ared with the flow pattern in a piston engine. The value of color Dopp ler ventriculography, e.g. in the prediction of thromboembolism, shoul d be established in a larger prospective study.