Oa. Smiseth et al., MECHANICS OF INTRAVENTRICULAR FILLING - STUDY OF LV EARLY DIASTOLIC PRESSURE-GRADIENTS AND FLOW VELOCITIES, American journal of physiology. Heart and circulatory physiology, 44(3), 1998, pp. 1062-1069
This study investigates mechanisms of left ventricular (LV) intracavit
ary flow during early, rapid filling. In eight coronary artery disease
patients with normal LV ejection fraction we recorded simultaneous LV
apical and outflow tract pressures and intraventricular flow velociti
es by color M-mode Doppler echocardiography. In five anesthetized dogs
we also recorded left atrial pressure and LV volume by sonomicrometry
. In patients, as the early diastolic mitral-to-apical filling wave ar
rived at the apex, we observed an apex-outflow tract pressure gradient
of 3.5 +/- 0.3 mmHg (mean +/- SE). This pressure gradient correlated
with peak early apex-to-outflow tract flow velocity (r = 0.75, P < 0.0
5). The gradient was reproduced in the dog model and decreased from 3.
1 +/- 0.3 to 1.7 +/- 0.5 mmHg (P < 0.05) with caval constriction and i
ncreased to 4.2 +/- 0.5 mmHg (P < 0.001) with volume loading. The pres
sure gradient correlated with peak early transmitral flow (expressed a
s time derivative of LV volume; r = 0.95) and stroke volume (r = 0.97)
. In conclusion, arrival of the early LV filling wave at the apex was
associated with a substantial pressure gradient between apex and outfl
ow tract. The pressure gradient was sensitive to changes in preload an
d correlated strongly with peak early transmitral flow. The significan
ce of this gradient for intraventricular flow propagation in the norma
l and the diseased heart remains to be determined.