Circulation, Vol 79, 1226-1236, Copyright © 1989 by American Heart Association
MF Stoddard, AC Pearson, MJ Kern, J Ratcliff, DG Mrosek and AJ Labovitz
We examined the influence of alterations in preload on pulsed Doppler
indexes of left ventricular diastolic function in 50 patients including 12
without cardiovascular disease, 29 with coronary artery disease, and nine
with critical aortic stenosis. Micromanometer left ventricular pressure was
recorded simultaneously with pulsed Doppler echocardiography of left
ventricular inflow and M-mode echocardiography of left ventricular
diameter. Chamber stiffness constants, kd and kv, were obtained from the
diastolic pressure-diameter and pressure-volume relations, respectively.
Relaxation was measured by the isovolumic relaxation time constants, TL and
TD, derived from the exponential left ventricular pressure decay and
maximum negative dP/dt. In 41 patients after nitroglycerin treatment, left
ventricular end-diastolic pressure decreased from 18 +/- 5 to 13 +/- 4 mm
Hg (p less than 0.001). The ratio of peak early to peak atrial filling
velocities and time-velocity integral ratios decreased from 1.08 +/- 0.57
to 0.90 +/- 0.42 (p less than 0.001) and from 1.77 +/- 0.95 to 1.41 +/-
0.71 (p less than 0.001), respectively. The peak early filling velocity and
time-velocity integral decreased from 56.1 +/- 15.7 to 49.9 +/- 14.5 cm/sec
(p less than 0.001) and from 7.9 +/- 2.7 to 6.8 +/- 2.8 cm (p less than
0.001), respectively. Relaxation (TL, TD, and maximum negative dP/dt) and
chamber stiffness (kd and kv) were not impaired after nitroglycerin
administration. In 48 patients after ventriculography, left ventricular
end-diastolic pressure increased from 18 +/- 6 to 22 +/- 8 mm Hg (p less
than 0.001). The peak early and peak atrial filling velocities increased
from 57.4 +/- 15.2 to 68.3 +/- 19.7 cm/sec (p less than 0.001) and from
61.0 +/- 22.7 to 69.4 +/- 23.2 cm/sec (p less than 0.01), respectively. As
a result, the ratio of peak early to peak atrial filling velocity was
unchanged. However, in the aortic stenosis group, the ratio of peak early
to peak atrial filling velocity increased from 0.95 +/- 0.64 to 1.10 +/-
0.72 (p less than 0.02). Relaxation and chamber stiffness were unchanged.
Thus, a reduction or increase in preload may induce a diastolic filling
pattern that mimics or masks diastolic dysfunction, respectively. Preload
conditions need to be accounted for when the status of diastolic function
is extrapolated from the pulsed Doppler mitral inflow velocity profile.
ARTICLES
Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans
Department of Internal Medicine, St. Louis University School of Medicine, Missouri.
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