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1 Cardiovascular Biophysics Laboratory, Cardiovascular MR Laboratories, Cardiovascular Division, Washington University School of Medicine, Saint Louis, MO, USA
* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.
Precise knowledge of the volume and rate of early rapid left ventricular (LV) filling elucidates kinematic aspects of diastolic physiology. The Doppler E-wave velocity-time integral (VTI) is conventionally used as the estimate of early rapid filling volume; however, this implicitly requires the assumption of a constant effective mitral valve area (EMVA). We sought to evaluate whether the EMVA is truly constant throughout early rapid filling in ten normal subjects using cardiac magnetic resonance imaging (MRI) and contemporaneous Doppler echocardiography, synchronized via the electrocardiogram. LV volume as a function of time was obtained via MRI, and transmitral flow was measured via Doppler echocardiography. The synchronized data were used to predict EMVA as a function of time during early diastole. Validation involved EMVA determination using: (1) the short-axis echocardiographic images near the mitral valve leaflet tips, (2) the distance between leaflet tips in the echocardiographic parasternal long-axis view, (3) the distance between leaflet tips from the MRI left ventricular outflow tract view. Predicted EMVA values varied substantially during early rapid filling, and observed EMVA values agreed well with prediction. We conclude that the EMVA is not constant, and its variation causes LV volume to increase faster than is reflected by the VTI. These results reveal the mechanism of early rapid volumetric increase and directly affect the significance and physiologic interpretation of the VTI of the Doppler E-wave. Application to subjects in selected pathophysiologic subsets is in progress.
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