Abstract 19554: Delayed Apical Filling Flow Momentum in the Spherical Failing Heart Related with Deteriorated Left Ventricular Suction
Background: Left ventricular (LV) untwisting has been reported to cause suction and facilitate apical flow filling. Intraventricular hemodynamics may play important role in effective LV filling, however, quantification of the flow energy has been difficult previously. Newly developed ultrasound technology enables calculating flow momentum without Doppler angle dependency. This study aimed to assess the magnitude and timing of the apical intraventricular flow momentum quantitatively and to investigate the relationship between LV diastolic function and geometry in failing heart.
Methods: Thirty patients with pseudonormalized Doppler LV filling pattern (pseudonormalized group; LVEF 54±19%) and 36 patients with normal pattern (normal group; LVEF 68±8%) were included. Flow momentum was calculated as the sum of the products of mass and velocity vector in apical lesion using Echo-Dynamography (Aloka). The peak early diastolic flow momentum and the time duration of peak momentum from base to apex (ΔT) was calculated. The momentum preservation was quantified as the difference of the peak momentum between basal and apical lesion (ΔM). The early diastolic untwisting rate was calculated as the parameter of LV suction by two-dimensional speckle tracking imaging. Sphericity index was calculated as long axis diameter divided by short axis diameter.
Results: ΔM was 46% in normal group and 40% in pseudonormalized group, and did not differ between two groups. In normal group, mean ΔT was 2±45 msec, and the timing of the peak momentum was almost simultaneous or earlier in apical lesion than in basal lesion. In peudonormalized group, mean ΔT was125±122ms, and significantly greater than that of the normal group. In univariate analysis, ΔT significantly correlated with untwisting rate (P<0.01, r=−0.41), LV end systolic volume (P<0.01, r=0.62), E' (P<0.01, r=−0.49), E/E' (P<0.01, r=0.66), sphericity index (P<0.01, r=−0.51), and LVEF (P<0.01, r=−0.62). In a stepwise analysis, untwisting rate, sphericity index were selected as independent determinants of ΔT.
Conclusion: Apical flow momentum was preserved but delayed in patients with LV diastolic dysfunction. Reduced LV suction and spherical morphology may associate with delayed apical flow energy filling.
- © 2010 by American Heart Association, Inc.