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1 Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195; and 2 Heart Center Limburg, Genk 3600, Belgium
Previous studies have shown that small
intraventricular pressure gradients (IVPG) are important for efficient
filling of the left ventricle (LV) and as a sensitive marker for
ischemia. Unfortunately, there has previously been no way of
measuring these noninvasively, severely limiting their research and
clinical utility. Color Doppler M-mode (CMM) echocardiography provides
a spatiotemporal velocity distribution along the inflow tract
throughout diastole, which we hypothesized would allow direct
estimation of IVPG by using the Euler equation. Digital CMM images,
obtained simultaneously with intracardiac pressure waveforms in six
dogs, were processed by numerical differentiation for the Euler
equation, then integrated to estimate IVPG and the total (left atrial
to left ventricular apex) pressure drop. CMM-derived estimates agreed
well with invasive measurements (IVPG: y = 0.87x + 0.22, r = 0.96, P < 0.001, standard error of the estimate = 0.35 mmHg). Quantitative processing of CMM data allows accurate estimation
of IVPG and tracking of changes induced by 
-adrenergic stimulation.
This novel approach provides unique information on LV filling dynamics
in an entirely noninvasive way that has previously not been available
for assessment of diastolic filling and function.
diastole; hemodynamics; ventricles
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