Noninvasive estimation of the rate of relaxation by the analysis of intraventricular pressure gradients

Abstract

Background-During late ejection, myocardial relaxation causes systolic flow to decelerate and stop, and this phenomenon is coupled with the generation of a pressure gradient inside the left ventricle (LV). We hypothesized that the peak reverse ejection intraventricular pressure difference (REIVPD) between the LV apex and the outflow tract could be a useful method to improve the assessment of LV relaxation using Doppler echocardiography. Methods and Results-Three sets of animal experiments and 1 clinical study were designed. In 6 pigs, a close relationship between REIVPD and the intensity of the relaxation wave (R rm=0.89) was demonstrated using wave intensity analysis of high-fidelity pressure-volume-velocity data. In 19 animals, REIVPD sensitively detected modifications of the lusotropic state and closely correlated with the time constant of LV relaxation (-) within animals (R rm=-0.93). Load-dependence analysis in 5 pigs showed that REIVPD remained stable up to values of 35% to 40% acute preload reduction. Clinical validation was tested in 50 patients (23 with normal systolic function) undergoing simultaneous Doppler echocardiography and high-fidelity LV pressure measurements on the same beat. REIVPD and tissue Doppler mitral annulus velocity (e') were independently related to τ, but the REIVPD-e' product correlated better with-than either variable separately (bootstrap-corrected correlation coefficients: R=-0.84 versus-0.71, and-0.70, respectively, P<0.05). Area under the receiver operating characteristic curve to predict impaired relaxation (τ>50 ms) for e'-REIVPD was 0.96 (95% confidence interval, 0.85 to 0.99). Conclusions-The Doppler-derived REIVPD provides a sensitive, reliable, reproducible, and relatively load-independent index of the rate of LV relaxation. Combined with tissue Doppler measurements of longitudinal function, this method improves noninvasive assessment of LV relaxation in the clinical setting. © 2011 American Heart Association, Inc.