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European Heart Journal 1992 13(6):832-839;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Determinants of left ventricular filling dynamics: alteration in the Doppler-derived transmitral filling profile with progressive impairment of cardiac function in a dog preparation

K. MIYAGUCHI, S. OGAWA, H. NOMURA, M. IWASE, M. YOKOTA* and H. HAYASHI

Department of Internal Medicine, Nagoya University School of Medicine Nagoya, Japan
*Department Clinical Laboratory, Nagoya University School of Medicine Nagoya, Japan

Received 6 December 1990; accepted 11 July 1991.

Correspondence. Kazuhiko Miyaguchi, MD, The First Department of Internal Medicine, Nagoya University School of Medicine, 65 Tsurumai, Showa-ku, Nagoya, 466 Japan

Abstract

To clarify the factors determining transmitral filling, left ventricular and atrial pressures (LVP and LAP) and Doppler-derived diastolic indices were analysed in six anaesthetized dogs at various right atrial pacing rates during dextran infusion. The relationship of the late to early diastolic peak velocity ratio (A/E ratio) to end-diastolic LVP (LVEDP) showed a quadratic curve concave to the LVEDP axis in five animals (r2= 0.320–0.588). An elevation in LVEDP up to 25 mmHg accompanied an increase in A/E ratio (ascending limb), and further LVEDP elevation caused its inverse decline (descending limb). Multiple regression analysis indicated that A/E ratio correlated positively with maximal L VP, a-wave LA P and heart rate, and negatively with v-wave LAP in both limbs. The time constant of isovolumic LVP decline, which was prolonged as LVEDP was elevated, was a positive correlate of A/E ratio in the ascending limb, but lost its influence on A/E ratio in the descending limb. An elevation in v-wave LAP must have masked the expected effect of left ventricular relaxation abnormality on A/E ratio in this limb. Thus, the transmitral filling profile did not alter unidirectionally, but returned to that seen before volume loading, with a simultaneous progressive impairment of cardiac function.

Key Words: Pulsed Doppler echocardiography • transmitral filling • diastolic property • loading condition


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