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      Intraventricular Isovolumic Relaxation Flow Patterns Improve the Predicting Power of Doppler Echocardiography for the Left Ventricular Filling Pressure in Patients with Anterior Wall Myocardial Infarction


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          Background and Purpose: Previous studies have shown that left ventricular systolic asynchrony affects both the relaxation and filling phases of diastole. The purpose of this study was to delinate how the anterior wall dyssynergy influenced the intraventricular flow redistribution patterns during the isovolumic relaxation (IVR) period, which delineated the changes in diastolic suction performance and, therefore, determined the significant Doppler flow variables for predicting left ventricular filling pressure. Methods: Seventy-three patients with anterior wall myocardial infarction and dyssynergy were enrolled. Those who exhibited the whole IVR intraventricular flow redistributing toward the mitral apparatus, which indicated the reverse physiologic intraventricular pressure gradient in early diastole, were classified as group B, otherwise, as group A. The Doppler echocardiographic variables of mitral inflow were correlated with the left ventricular end-diastolic pressures (LVEDP). Results: With lower ejection fraction rate and more apical dyssynergy, the group B patients had much slower mitral flow propagation. For group A patients, the independent determinants for LVEDP were the ratio of mitral flow propagation rate to peak velocity in early diastole, the early mitral flow deceleration time and the IVR time, all occurring in early diastole. In contrast, the only independent determinant for LVEDP in group B patients was the ratio of mitral peak flow velocity in early diastole to that in late diastole. Conclusions: The intraventricular IVR flow patterns could delineate how the left ventricular systolic dyssynergy influenced the diastolic process, and determine which echocardiographic variables were more useful for predicting LVEDP in patients with anterior wall myocardial infarction.

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          Is the Blood Flow in the Left Ventricle during the Isovolumic Relaxation Period a Useful Parameter of Left Ventricular Systolic and Early Diastolic Performance?

          Left ventricular (LV) early diastolic performance is determined by LV behavior in the late systole to early diastole and may relate to the physical potential of patients. Isovolumic relaxation flow (IRF) velocity was obtained by continuous Doppler echocardiography in the left ventricle from the apex in 26 patients with atypical chest pain and 63 patients with coronary artery disease (CAD) with or without prior myocardial infarction (MI) who underwent cardiac catheterization. In each patient, a time constant of LV relaxation (τ) was calculated from the LV pressure waves obtained by a catheter-tipped micromanometer. The LV end-systolic volume index was measured using contrast left ventriculography. IRF velocity in patients having CAD with prior MI (24.8 ± 5.4 cm/s) was significantly less than in those with atypical chest pain (41.2 ± 9.6 cm/s). It was also significantly less than in patients having CAD without prior MI (37.3 ± 6.8 cm/s). IRF velocity significantly correlated with the time constant τ (r = –0.42, p < 0.001) and LV end-systolic volume index (r = –0.84, p < 0.001). This study indicates that IRF velocity obtained by continuous Doppler echocardiography in the left ventricle provides important information regarding LV systolic performance and early diastolic performance.

            Author and article information

            S. Karger AG
            February 2001
            02 March 2001
            : 94
            : 3
            : 200-207
            Department of Internal Medicine (Cardiology Section), National Taiwan University Hospital, Taipei, Taiwan
            47317 Cardiology 2000;94:200–207
            © 2001 S. Karger AG, Basel

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            Page count
            Figures: 3, Tables: 3, References: 31, Pages: 8
            Non-Invasive Diagnostic Echocardiography


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