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1Department of Internal Medicine, Cardiovascular Biophysics Laboratory, Cardiovascular Division, Washington University School of Medicine; and 2Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University, St. Louis, Missouri
Submitted 19 December 2005 ; accepted in final form 30 March 2006
Previous studies in healthy humans have established that the (
850 ml) volume enclosed by the pericardial sac is nearly constant over the cardiac cycle, exhibiting a transient 5% decrease (40 ml) from end diastole to end systole. This volume decrease manifests as a "crescent" at the ventricular free wall level when short-axis MRI images of the epicardial surface acquired at end systole and end diastole are superimposed. On the basis of the (near) constant-volume property of the four-chambered heart, the volume decrease ("crescent effect") must be restored during subsequent early diastolic filling via the left atrial conduit volume. Therefore, volume conservation-based modeling predicts that pulmonary venous (PV) Doppler D-wave volume must be causally related to the radial displacement of the epicardium (
) (i.e., magnitude of "crescent effect" in the radial direction). We measured from M-mode echocardiographic images and measured D-wave velocity-time integral (VTI) from Doppler PV flow of the right superior PV in 11 subjects with catheterization-determined normal physiology. In accordance with model prediction, high correlation was observed between and D-wave VTI (r = 0.86) and early D-wave VTI measured to peak D-wave velocity (r = 0.84). Furthermore, selected subjects with various pathological conditions had values of that differed significantly. These observations demonstrate the volume conservation-based causal relationship between radial pericardial displacement of the left ventricle and the PV D-wave-generated filling volume in healthy subjects as well as the potential role of the M-mode echo-derived radial epicardial displacement index as a regional (radial) parameter of diastolic function.
constant-volume heart; left atrial conduit volume
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