Document Detail


The E-wave delayed relaxation pattern to LV pressure contour relation: model-based prediction with in vivo validation.
MedLine Citation:
PMID:  20172449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The transmitral Doppler E-wave "delayed relaxation" (DR) pattern is an established sign of diastolic dysfunction (DD). Furthermore, chambers exhibiting a DR filling pattern are also expected to have a prolonged time-constant of isovolumic relaxation (tau). The simultaneous observation of a DR pattern and normal tau in the same heart is not uncommon, however. The simultaneous hemodynamic equivalent of the DR pattern has not been proposed. To determine the feature of the left ventricular (LV) pressure contour during the E-wave that is causally related to its DR pattern we applied kinematic and fluid mechanics based arguments to derive the pressure recovery ratio (PRR). The PRR is dimensionless and is defined by the left ventricular pressure difference between diastasis and minimum pressure, normalized to the pressure difference between a fiducial diastolic filling pressure and minimum pressure [PRR=(P(Diastasis)-P(Min))/(P(Fiducial)-P(Min))]. We analyzed 354 cardiac cycles from 40 normal sinus rhythm (NSR) subjects and 113 beats from nine atrial fibrillation (AF) subjects from our database of simultaneous transmitral flow-micromanometric LV pressure recordings. The fiducial pressure is defined by the end diastolic pressure in NSR and by the pressure at dP/dt(MIN) in the setting of AF. Consistent with derivation, PRR was linearly related to a DR pattern related, model-based relaxation parameter (R(2) = 0.77, 0.83 in NSR and AF, respectively). Furthermore, the PRR successfully differentiated subjects with a DR pattern from subjects with partial DR or normal E-wave pattern (p < 0.05). We conclude that the PRR may differentiate between subjects having a DR pattern and subjects with normal E-waves, even when tau cannot.
Authors:
Wei Zhang; Leonid Shmuylovich; S?ndor J Kov?cs
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Validation Studies    
Journal Detail:
Title:  Ultrasound in medicine & biology     Volume:  36     ISSN:  1879-291X     ISO Abbreviation:  Ultrasound Med Biol     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-22     Completed Date:  2010-05-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0410553     Medline TA:  Ultrasound Med Biol     Country:  England    
Other Details:
Languages:  eng     Pagination:  497-511     Citation Subset:  IM    
Copyright Information:
Copyright 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Biophysics Laboratory, Department of Physics, College of Arts and Sciences, St. Louis, MO, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Atrial Fibrillation / ultrasonography
Female
Hemodynamics
Humans
Male
Middle Aged
Retrospective Studies
Ventricular Dysfunction, Left / ultrasonography*

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