Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study (Reprinted from the Journal of the American College of Cardiology, August, 1988)

In an effort to determine what clinically useful information regarding left ventricular diastolic function can be inferred noninvasively with pulsed w ave Doppler echocardiography, mitral flow velocity patterns and measured va riables were correlated with hemodynamic findings in 70 patients: 30 with c oronary artery disease, 20 with idiopathic congestive cardiomyopathy, 14 wi th a restrictive myocardial process and 6 without significant cardiac disea se. The effect of sudden changes in hemodynamics on the mitral flow velocit y pattern was also investigated in a subgroup of patients who had simultane ous recording of mitral flow velocity and left ventricular pressure before and after left ventriculography. Mitral flow velocity recordings from 30 he althy adults served as a reference group. This analysis suggests that 1) th e majority of patients with these cardiac disorders demonstrate abnormal mi tral flow velocity patterns or variables; 2) markedly different flow veloci ty patterns can be seen in patients with impaired left ventricular relaxati on; 3) the different mitral patterns appear to relate more to myocardial fu nction and hemodynamic status than to the type of disease process present; 4) certain mitral patterns suggest different filling pressures and rates of early diastolic left ventricular filling; 5) an increase in left atrial pr essure can "normalize" an abnormal mitral flow velocity pattern and "mask" a left ventricular relaxation abnormality; and 6) the different patterns ap pear to represent a dynamic continuum with the potential to change from one to another as a result of disease progression, medical therapy or sudden c hanges in hemodynamics. It is concluded that, despite the indirect method o f estimation and certain limitations, mitral flow velocity recordings have clinical potential in assessing left ventricular diastolic function that me rits further investigation.