IMPORTANCE OF LEFT-VENTRICULAR SYSTOLIC FUNCTION IN THE ASSESSMENT OF LEFT-VENTRICULAR DIASTOLIC FUNCTION WITH DOPPLER TRANSMITRAL FLOW VELOCITY RECORDING

To study the effect of left ventricular systolic function on the Doppler transmitral flow velocity pattern, Doppler echocardiographic variables were correlated with hemodynamic indexes in 11 control subjects and 58 patients with heart disease. All underwent cardiac catheterization performed with use of a Millar micromanometer. The time constant of left ventricular isovolumetric pressure decrease and left ventricular end-diastolic myocardial stiffness was calculated. The 58 patients were classified into two groups according to ejection fraction: group I (n = 30; ejection fraction > 55%) and group II (n = 28; ejection fraction < 50%). Compared with the control subjects, patients in group I had impairment only of left ventricular relaxation (time constant 47 +/-9 vs. 38 +/- 3 ms; p < 0.01), whereas patients in group II had, in addition to impaired left ventricular relaxation (time constant 52 +/- 11 vs. 38 +/- 3 ms; p < 0.01), increased preload, increased pulmonary capillary pressure (12 +/- 8 vs. 5 t 3 mm Hg; p < 0.01) and increased myocardial stiffness (2,018 +/- 980 vs. 1,050 +/- 218 g/cm2; p < 0.01). In group I, there was a significant partial correlation coefficient between the time constant and deceleration half-time (r = 0.54). In group II, a strong correlation existed between myocardial stiffness and peak atrial filling velocity (r = -0.71) and between myocardial stiffness and the ratio of peak atrial to peak rapid filling velocity (r = -0.71). Despite the impairment of left ventricular relaxation in group II, the deceleration half-time was shorter (72 +/- 24 ms) than in the control group (87 +/- 13 ms; p < 0.05) or in group I (108 +/- 27 ms; p < 0.01). These data suggest that deceleration half-time reflects left ventricular relaxation in patients with a normal ejection fraction. Conversely, in patients with a decreased ejection fraction, peak atrial filling velocity reflects left ventricular stiffness and the impairment of left ventricular relaxation does not influence subsequent rapid ventricular filling.