Evaluation of LV diastolic function from color M-mode echocardiography

Abstract

Objectives: this study evaluated early diastolic filling dynamics using a semiautomated objective analysis of filling velocities obtained from color M-mode echocardiography.

Background: diastolic function can be evaluated from color M-mode echocardiography by measuring the early diastolic flow propagation velocity (Vp) from the slope of a single linear approximation of an isovelocity contour. However, this method has limitations and may not accurately represent diastolic filling.

Methods: we used a semiautomated objective analysis of color M-mode echocardiograms from a development cohort of 125 patients with varying diastolic function to quantify left ventricular filling velocities. Early diastolic filling was not accurately described with a single propagation velocity; instead, the rapid initial filling velocity abruptly decelerated to a slower terminal velocity. Then, we evaluated a new measure of diastolic function in a separate group of 160 patients.

Results: compared with normal filling, diastolic dysfunction with restricted filling had a lower initial velocity (53 ± 21 cm/s vs. 87 ± 29 cm/s, p < 0.001), and the deceleration point occurred closer to the mitral annulus (2.4 ± 0.6 cm vs. 3.1 ± 0.7 cm, p < 0.05). The product of the initial velocity and the distance to the deceleration point from the mitral annulus, indicating the strength of the early filling (Vs), was progressively reduced with diastolic dysfunction. In a separate validation cohort of 160 patients, Vs better recognized diastolic dysfunction (classified by reduced diastolic intraventricular pressure gradient, elevated pulmonary capillary wedge pressure, or elevated B-type natriuretic peptide) than Vp did.

Conclusions: early diastolic flow propagation occurs with an initial rapid velocity that abruptly decelerates to a terminal velocity. With diastolic dysfunction, the initial velocity is slower and the deceleration point occurs closer to the mitral annulus than with normal filling. A new parameter that combines these 2 effects (Vs) provides a more accurate assessment of diastolic function than the conventional propagation velocity.