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(Circulation. 2005;112:1771-1779.)
© 2005 American Heart Association, Inc.

Imaging

Doppler-Derived Ejection Intraventricular Pressure Gradients Provide a Reliable Assessment of Left Ventricular Systolic Chamber Function

Raquel Yotti, MD; Javier Bermejo, MD, PhD; M. Mar Desco, MD, PhD; J. Carlos Antoranz, PhD; José Luis Rojo-Álvarez, MEng, PhD; Cristina Cortina, MD; Carmen Allué, RDNS; Hugo Rodríguez-Abella, MD; Mar Moreno, MD, PhD; Miguel A. García-Fernández, MD, PhD

From the Department of Cardiology (R.Y., J.B., C.C., C.A., M.M., M.A.G.-F.), Unit of Experimental Medicine and Surgery (M.M.D.), and Department of Cardiovascular Surgery (H.R.-A.), Hospital General Universitario Gregorio Marañón, Madrid; Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Distancia (J.C.A.); and Department of Signal Theory and Communications, Universidad Carlos III de Madrid, Madrid (J.L.R.-A.), Spain.

Correspondence to Javier Bermejo, MD, PhD, Laboratory of Echocardiography, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, 28007 Madrid, Spain. E-mail javbermejo{at}jet.es

Received June 16, 2004; revision received February 10, 2005; accepted June 1, 2005.

Background— Ejection intraventricular pressure gradients are caused by the systolic force developed by the left ventricle (LV). By postprocessing color Doppler M-mode (CDMM) images, we can measure noninvasively the ejection intraventricular pressure difference (EIVPD) between the LV apex and the outflow tract. This study was designed to assess the value of Doppler-derived EIVPDs as noninvasive indices of systolic chamber function.

Methods and Results— CDMM images and pressure-volume (conductance) signals were simultaneously acquired in 9 minipigs undergoing pharmacological interventions and acute ischemia. Inertial, convective, and total EIVPD curves were calculated from CDMM recordings. Peak EIVPD closely correlated with indices of systolic function based on the pressure-volume relationship: peak elastance (within-animal R=0.98; between-animals R=0.99), preload recruitable stroke work (within-animal R=0.81; between-animals R=0.86), and peak of the first derivative of pressure corrected for end-diastolic volume (within-animal R=0.88; between-animals R=0.91). The correlation of peak inertial EIVPD with these indices was also high (all R>0.75). Load dependence of EIVPDs was studied in another 5 animals in which consecutive beats obtained during load manipulation were analyzed. During caval occlusion (40% EDV reduction), dP/dt_max, ejection fraction, and stroke volume significantly changed, whereas peak EIVPD remained constant. Aortic occlusion (40% peak LV pressure increase) significantly modified dP/dt_max, ejection fraction, and stroke volume; a nearly significant trend toward decreasing peak EIVPD was observed (P=0.06), whereas inertial EIVPD was unchanged (P=0.6). EIVPD beat-to-beat and interobserver variabilities were 2±12% and 5±11%, respectively.

Conclusions— Doppler-derived EIVPDs provide quantitative, reproducible, and relatively load-independent indices of global systolic chamber function that correlate closely with currently available reference methods.

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