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Am J Physiol Heart Circ Physiol 280: H554-H561, 2001;
0363-6135/01 $5.00
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Vol. 280, Issue 2, H554-H561, February 2001

Estimation of left ventricular operating stiffness from Doppler early filling deceleration time in humans

Mario J. Garcia1, Michael S. Firstenberg1, Neil L. Greenberg1, Nicholas Smedira2, Leonardo Rodriguez1, David Prior1, and James D. Thomas1

1 Cardiovascular Imaging Center, Departments of Cardiology and 2 Cardiothoracic Sugery, Cleveland Clinic Foundation, Cleveland, Ohio 44195

Shortened early transmitral deceleration times (EDT) have been qualitatively associated with increased filling pressure and reduced survival in patients with cardiac disease and increased left ventricular operating stiffness (KLV). An equation relating KLV quantitatively to EDT has previously been described in a canine model but not in humans. During several varying hemodynamic conditions, we studied 18 patients undergoing open-heart surgery. Transesophageal echocardiographic two-dimensional volumes and Doppler flows were combined with high-fidelity left atrial (LA) and left ventricular (LV) pressures to determine KLV. From digitized Doppler recordings, EDT was measured and compared against changes in LV and LA diastolic volumes and pressures. EDT (180 ± 39 ms) was inversely associated with LV end-diastolic pressures (r = -0.56, P = 0.004) and net atrioventricular stiffness (r = -0.55, P = 0.006) but had its strongest association with KLV (r = -0.81, P < 0.001). KLV was predicted assuming a nonrestrictive orifice (Knonrest) from EDT as Knonrest = (0.07/EDT)2 with KLV = 1.01 Knonrest - 0.02; r = 0.86, P < 0.001, Delta K (Knonrest - KLV) = 0.02 ± 0.06 mmHg/ml. In adults with cardiac disease, EDT provides an accurate estimate of LV operating stiffness and supports its application as a practical noninvasive index in the evaluation of diastolic function.

diastole; echocardiography; myocardial stiffness


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