Abstract
The effect of diastolic dysfunction (DD) on the timing of left ventricular (LV) diastolic longitudinal and circumferential expansion and their load dependence is not known. This study evaluated the timing of the peak early diastolic LV inflow velocity (E), mitral annular velocity (e′), and longitudinal and circumferential global strain rates (SRE) in 161 patients in sinus rhythm. The intraventricular pressure difference (IVPD) from the left atrium to the LV apex was obtained using color M‐mode Doppler data to integrate the Euler equation. The diastolic function was graded according to the guidelines. In normals (N = 57), E, e′, longitudinal SRE, and circumferential SRE occurred nearly simultaneously during the IVPD. With DD (N = 104), e′ and longitudinal SRE were delayed occurring after the IVPD (e′: 18 ± 23 msec, longitudinal SRE: 13 ± 21 msec from the IVPD), whereas circumferential SRE (−8 ± 28 msec) and E (−2 ± 13 msec) were not delayed. The normal dependence of e′ and longitudinal SRE on IVPD was reduced in DD; while the relation of circumferential SRE and E to IVPD were unchanged in DD. Thus, normally, the LV expands symmetrically during early diastole and both longitudinal and circumferential expansions are related to the IVPD. With DD, early diastolic longitudinal LV expansion is delayed, occurring after the IVPD and LV filling, resulting in their relative independence from the IVPD. In contrast, with DD, circumferential SRE and mitral inflow are not delayed and their normal relation to the IVPD is unchanged.
Highlights
Among the 161 patients, diastolic function was classified as NL in 49 patients, as impaired relaxation (IR) in eight patients, as PN in 47 patients, and as restrictive filling (RF) in 57 patients
LV ejection fraction was lower in IR, PN, and RF than in NL
E0 was lower in IR, PN, and RF than in NL and E to e0 (E/e0) was higher in PN and RF than in NL
Summary
We analyzed consecutive patients who underwent clinically indicated transthoracic echocardiography using the same ultrasound system (Vivid E9, GE Vingmed, Horten, Norway) at Wake Forest Baptist Medical Center from January 2012 to May 2013. Patients with significant leftside valvular disease, prosthetic valve, pericardial disease, LV assist device, nonsinus rhythm, left bundle branch block, fusion of early and late diastolic mitral inflow, and patients after heart transplantation were excluded. From 226 patients who were eligible for the study inclusion, 51 patients with inadequate echocardiographic image quality and 14 patients who lacked full data sets were excluded. This study consisted of 161 patients (Fig. 1). The study protocol was approved by the Institutional Review Board of Wake Forest School of Medicine (IRB00012599)
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