DOPPLER ECHOCARDIOGRAPHIC ANALYSIS OF LEFT-VENTRICULAR DIASTOLIC BLOOD-FLOW

We analyzed the diastolic flow pattern in the left ventricle by means of pulsed Doppler echocardiography in 150 consecutive patients (51 +/- 14 years old) with various cardiac conditions. The flow pattern typical of the left ventricular inflow tract (E and A) was duplicated in the outflow tract and on the lateral wall in the form of a reversed biphasic pattern (E* and A*) extended into the phase of isovolumic contraction. E* was delayed by 72 +/- 44 msec compared to E, A* was only delayed by 47 +/- 31 msec compared to A (a significant difference in the delays, P < 0.0001). In patients with left ventricular hypertrophy (n = 23), the delay of E* compared to E was greater than in normal subjects (n = 60) (91 +/- 52 as compared to 66 +/- 37 msec; P < 0.01). In three patients with constrictive pericarditis, the delay A/A* was greater than the delay E/E*, in contrast to the situation in normal subjects and patients with left ventricular hypertrophy. During isovolumic relaxation, acceleration of flow toward the apex was found near the septum in 77% of the patients. In 20 patients, an intraobserver, interobserver, cycle-to-cycle, technician-to-technician, and day-to-day test of the variability of 19 Doppler parameters was carried out. In general, the largest differences were shown in the day-to-day and the technician-to-technician testing. Of the inflow tract measurements, upsilon-max E and upsilon-max A and their time-velocity integrals were readily reproducible. The reproducibility of acceleration and deceleration slope measurement was not so good. In the outflow tract, upsilon-max E*, the time-velocity integral of E* and the delay between A and A* were well reproducible. No sources of variability specific to individual patients were shown for the flow during the isovolumic relaxation phase, but there were significant differences in the technician-to-technician and interobserver variability testing. Thus, information on diastolic flow behavior in the left ventricle may be obtained by Doppler echocardiography. This provides more information than that obtainable by analysis of the inflow profile alone. The addition of these parameters to analysis of transmitral flow patterns might allow enhanced appraisal of abnormalities not only in muscular relaxation but also in chamber compliance.