Assessment of Left Ventricular Diastolic Dysfunction by Intraventricular Dispersion of Early Diastolic Filling

Byung Soo Kim; Yong Woo Jang; Ju II Lee; Won Tae Chung; Moo Hyun Kim; Jong Seong Kim

doi:10.3803/jkes.1996.4.1.66

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Kim, Jang, Lee, Chung, Kim, and Kim: Assessment of Left Ventricular Diastolic Dysfunction by Intraventricular Dispersion of Early Diastolic Filling

Original Article

J Korean Soc Echocardiogr 1996;4(1):66-71.

Published online: 18 February 1996

DOI: https://doi.org/10.3803/jkes.1996.4.1.66

Assessment of Left Ventricular Diastolic Dysfunction by Intraventricular Dispersion of Early Diastolic Filling

Byung Soo Kim, M.D., Yong Woo Jang, M.D., Ju II Lee, M.D., Won Tae Chung, M.D., Moo Hyun Kim, M.D., Jong Seong Kim, M.D.

Department of Internal Medicine, College of Medicine, Dong-A University, Pusan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Analysis of mitral flow velocity pattern provides useful variables in the assessment of left ventricular diastolic dysfuntion, but are affected by loading conditions or presence of atrial fibrillation. Thus we assessed intraventricular diastolic flow velocity profile in order to assessment of left ventricular diastolic dysfuntion.

Methods

The study population consisted of 20 subjects with normal left ventricular function(including 7 patients with atrial fibrillation only), 15 patients with hypertensive heart disease, and 14 patients with dilated cardiomyopathy. The flow velocity pattern at the mitral tip was recorded simultaneously with regional pulsed Doppler diastolic velocity patterns at 1,2, or 3 cm from the mitral tip toward the apex.

Results

In the normal subjects, early diastolic flow velocity at the mitral tip was maintained at the positions 1 to 3cm away from the tip into the left ventricular cavity. In patients with dilated cardiomyopathy or hypertensive heart disease, peak early diastolic flow velocity decreased from the mitral tip toward the apex more progressively than in the subjects with normal left ventricular function. The same findings were obtained in selected patients group with atrial fibrillation or a normalized mitral flow velocity pattern.

Conclusion

The assessments of the intraventricular dispersion in peak early diastolic flow velocity may be useful in detecting left ventricular diastolic dysfuntion, particularly in patients with atrial fibrillation or a normalized mitral flow velocity pattern.

Keywords: Diastolic dysfuction, Intraventricular dispersion.

References

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Fig. 1.

Comparison of ratio of regional peak early diastolic flow velocity to E among subjects with normal LV function, patients with hypertensive heart disease (HHD), and Patients with dilated cardiomyopathy (DCMP).

Values are mean.

Fig. 2.

Comparison of ratio of regional peak early diastolic flow velocity to E among subjects with normal LV function, patients with dilated cardiomyopathy (DCMP) with E/A ratio of > 1, and with E/A ratio of <1.

Values are mean.

Fig. 3.

Comparison of ratio of regional peak early diastolic flow velocity to E among patients with Af only, patients with hypertensive heart disease(HHD), and Af, and patients with dilated cardiomyopathy (DCMP) and with Af.

Values are mean.

Table 1.

Clinical characteristics and echocardiographic measurements

	Normal LV function	HHD	DCMP
Number	20(13 ± 7^†)	15(9 ± 6^†)	14(9 ± 5^†)
Age(yr)	43 ± 15	58 ± 18	51 ± 9
HR(beats/min)	71 ± 13	77 ± 14	76 ± 14
LVEDd(mm)	50 ± 7	49 ± 6	66 ± 4^∗1)
LVEDs(mm)	34 ± 4	33 ± 5	55 ± 7^∗,1)
EF(%)	61 ± 8	63 ± 6	28 ± 5^∗,1)

Values are mean±SD

HHD, hypertensive heart disease; DCMP, dilated cardiomyopathy: LVEDd/s, left ventricular end-diastolic / systolic diameter

^† : with atrial fibrillation

^∗ p < 0.05 vs normal LV function

¹⁾ p < 0.05 vs HHD

Table 2.

Doppler parameters of LV diastolic function

	Normal LV function	HHD	DCMP
	n=13	n=9	n=9
IVRT(ms)	79 ± 10	92 ± 9^∗	105 ± 35^∗
E(cm/sec)	68 ± 20	59 ± 5	66 ± 13
A(cm / sec)	52 ± 13	67 ± 15	65 ± 21
E/A	1.2 ± 0.6	0.9 ± 0.4	1.0 ± 0.9
DT(ms)	180 ± 21	238 ± 17	175 ± 51

Values are mean ± SD

HHD, hypertensive heart disease; DCMP, dilated cardiomyopathy: LVEDd/s, left ventricular end-diastolic/systolic diameter: IVRT, isovolemic relaxion time

^∗ p < 0.05 vs normal LV function

Table 3.

Indexes of mitral flow pattern and echocardiogram in normal LV function and patients with DCMP

	Normal LV function with sinus rhythm n=13	DCMP with sinus rhythm
	Normal LV function with sinus rhythm n=13	E/A<1	E/A>1
	n=13	n=6	n=6
IVRT(ms)	79 ± 10	127 ± 34^∗	82 ± 41^†
E(cm/sec)	68 ± 20	45 ± 8^∗	72 ± 31^†
A(cm/sec)	52 ± 13	55 ± 12	27 ± 13^∗,†
E/A	1.2 ± 0.6	0.8 ± 0.3	2.7 ± 1.2^†
LVEDd(mm)	50 ± 8	64 ± 9^∗	68 ± 8^∗
LVEDs(mm)	33 ± 6	55 ± 6^∗	54 ± 6^∗
EF(%)	63 ± 7	28 ± 7^∗	27 ± 9^∗

Values are mean±SD

HHD, hypertensive heart disease; DCMP, dilated cardiomyopathy; LVEDd/s, left ventricular end-diastolic/systolic diameter: IVRT, isovolemic relaxion time

^∗ p < 0.05 vs normal LV function

^† p < 0.05 vs DCMP with E/A < 1

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