Identification of pseudonormal transmitral flow pattern using color Doppler echocardiography.

Abstract

The jet size of flow in color Doppler is dependent on both jet momentum and the compliance of the receiving chamber. Thus, the jet size of left ventricular (LV) late filling standardized by its jet momentum should reflect LV compliance. We investigated the feasibility of using color Doppler echocardiography to differentiate a pseudonormal from a normal transmitral flow pattern. We divided 37 patients with ischemic heart diseases who demonstrated a "normal" transmitral flow pattern into 2 groups according to their LV end diastolic pressure (LVEDP): a pseudonormalization group (LVEDP > or = 18 mmHg, 16 patients), and a normal group (LVEDP < 18 mmHg, 21 patients). We measured the maximum color Doppler jet length (L) and the peak velocity of transmitral flow during atrial contraction (Av). Filling volume (Q) was measured as the increase in LV volume during atrial contraction. A simplified jet momentum index (M) was obtained from Av x Q, and L/M was considered to reflect LV compliance. L/M was significantly lower in the pseudonormalization group that in the normal group (1.55 +/- 0.46 x 10(-3) vs 2.72 +/- 0.59 x 10(-3) p < 0.01). On the other hand, conventional Doppler variables such as isovolumic relaxation time and the deceleration time of early diastolic filling were not sufficient for discriminating between the 2 groups. In conclusion, color Doppler echocardiogram during atrial contraction was useful for differentiating a pseudonormal from a normal transmitral flow pattern.