Quantitative Assessment of Left Ventricular Diastolic Stiffness in Man

An approach to the quantitative assessment of left ventricular (LV) diastolic stiffness in man has been developed utilizing strip-chart recordings of simultaneous ultrasonic LV dimensions, LV pressure, and electrocardiogram (ECG). In 23 patients without regional abnormalities of contraction, LV pressure, and LV internal diameter (D = distance between endocardial surfaces of LV posterior wall and septum at the plane of the mitral valve) were determined at the onset (P1, D1) and peak (P2, D2) of left atrial mechanical systole. In addition, left ventricular volumes, V1 and V2, were calculated from D1 and D2 using a regression formula for end-diastolic volume previously determined from biplane angiographic studies. This allowed calculation of &Dgr;P/&Dgr;D and &Dgr;P/&Dgr;V associated with the “a” wave of the LV pressure trace, and these ratios were utilized as measures of LV stiffness late in diastole.Patients with LV hypertrophy by standard ECG criteria had much greater late diastolic stiffness (11 patients, &Dgr;P/&Dgr;D = 6.1 ± 1.1 mm Hg/mm, &Dgr;P/&Dgr;V = 1.0 ± 0.2 mm Hg/cc) than those without LV hypertrophy (12 patients, &Dgr;P/&Dgr;D = 1.8 ± 0.2 mm Hg/mm, &Dgr;P/&Dgr;V = 0.29 ± 0.04 mm Hg/cc, P < 0.001 for each ratio).Comparison of the stiffness ratios showed significant variation among patients with different disease states. Thus, late diastolic stiffness was highest in patients with aortic stenosis (three patients, &Dgr;P/&Dgr;D = 8.9 ± 2.9 mm Hg/mm, &Dgr;P/&Dgr;V = 1.5 ± 0.5 mm Hg/cc), lowest in mitral stenosis (four patients, &Dgr;P/&Dgr;D = 1.5 ± 0.5 mm Hg/mm, &Dgr;P/&Dgr;V = 0.23 ± 0.06 mm Hg/cc), and intermediate in patients with aortic regurgitation (three patients, &Dgr;P/&Dgr;D = 4.8 ± 0.7 mm Hg/mm, &Dgr;P/&Dgr;V = 0.83 ± 0.12 mm Hg/cc) and mitral regurgitation (three patients, &Dgr;P/&Dgr;D = 3.2 ± 0.7 mm Hg/mm, &Dgr;P/&Dgr;V = 0.5 ± 0.1 mm Hg/cc).It is concluded that the quantitative evaluation of LV diastolic stiffness obtained by this approach correlates well with the presence or absence of LV hypertrophy and with the underlying pathophysiology.

[1]  J. Covell,et al.  Left Ventricular Dilatation and Diastolic Compliance Changes during Chronic Volume Overloading , 1972, Circulation.

[2]  W. Gaasch,et al.  Left Ventricular Stress and Compliance in Man: With Special Reference to Normalized Ventricular Function Curves , 1972, Circulation.

[3]  H Feigenbaum,et al.  Ultrasound measurements of the left ventricle. A correlative study with angiocardiography. , 1972, Archives of internal medicine.

[4]  G. Diamond,et al.  Effect of Coronary Artery Disease and Acute Myocardial Infarction on Left Ventricular Compliance in Man , 1972, Circulation.

[5]  N. Fortuin,et al.  Determination of Left Ventricular Volumes by Ultrasound , 1971, Circulation.

[6]  G. Diamond,et al.  Dlastolic Pressure‐Volume Relationship in the Canine Left Ventricle , 1971 .

[7]  R. Russell,et al.  Left Ventricular Volumes and Ejection Fraction by Echocardiography , 1971, Circulation.

[8]  G. Diamond,et al.  Diastolic pressure-volume relationship in the canine left ventricle. , 1971, Circulation research.

[9]  J. Bristow,et al.  Systolic and Diastolic Abnormalities of the Left Ventricle in Coronary Artery Disease: Studies in Patients with Little or No Enlargement of Ventricular Volume , 1970, Circulation.

[10]  W. Hood,et al.  Experimental myocardial infarction. IV. Reduction of left ventricular compliance in the healing phase. , 1970, The Journal of clinical investigation.

[11]  H Feigenbaum,et al.  Estimation of right and left ventricular size by ultrasound. A study of the echoes from the interventricular septum. , 1969, The American journal of cardiology.

[12]  M. Noble,et al.  Left Ventricular Filling and Diastolic Pressure‐Volume Relations in the Conscious Dog , 1969, Circulation research.

[13]  H Sandler,et al.  Usefulness and limitations of radiographic methods for determining left ventricular volume. , 1966, The American journal of cardiology.

[14]  W. Hood,et al.  Pressure‐Volume Correlates of Left Ventricular Oxygen Consumption in the Hypervolemic Dog , 1965, Circulation research.

[15]  H. Dodge,et al.  Pressure-volume characteristics of the diastolic left ventricle of man with heart disease , 1962 .

[16]  L. Hefner,et al.  Distensibility of the dog left ventricle. , 1961, The American journal of physiology.

[17]  J. Mitchell,et al.  Influence of Cardiac Sympathetic and Vagal Nerve Stimulation on the Relation Between Left Ventricular Diastolic Pressure and Myocardial Segment Length , 1960, Circulation research.

[18]  A. Fishman,et al.  Time Relationship of Dynamic Events in the Cardiac Chambers, Pulmonary Artery and Aorta in Man , 1956, Circulation research.