Assessment of transmitral vortex formation in patients with diastolic dysfunction.

BACKGROUND Previous experimental models have related transmitral vortex formation to the longitudinal recoil of left ventricle. However, little is known about the relationships among left ventricular (LV) longitudinal relaxation, transmitral filling patterns, and LV vortex formation in clinical settings. The aim of this study was to compare the vortex formation time index among a heterogeneous group of patients with diastolic dysfunction to understand the relationship between transmitral vortex formation and abnormal diastolic filling patterns. METHODS Echocardiographic data from 107 subjects were retrospectively evaluated. The study population was categorized into four groups on the basis of transmitral early and late diastolic Doppler filling patterns as normal (n = 45), impaired relaxation (n = 14), pseudonormal (n = 26), and restrictive (n = 22). Vortex formation time was computed from the governing equations based on transmitral flow and ejection fraction. RESULTS Differences in vortex formation time index were found to be significant among all the studied groups (P < .0001). The trend of vortex formation during a cardiac cycle was compared in normal hearts and those with diastolic dysfunction. Mitral annular velocity (e') was found to decrease significantly (P < .0001) in subjects with abnormal transmitral filling patterns compared with normal subjects. The difference in e' among all the affected groups was not found to be significant (P = .68). CONCLUSIONS The findings of this study suggest that patients with different patterns of transmitral diastolic filling show significant changes in LV vortex formation time despite the absence of significant differences in mitral annulus recoil during diastole.

[1]  L. Dreifus,et al.  Biplane measurements of left and right ventricular volumes using wide angle cross-sectional echocardiography , 1978 .

[2]  Gianni Pedrizzetti,et al.  Intraventricular vortex flow changes in the infarcted left ventricle: numerical results in an idealised 3D shape , 2011, Computer methods in biomechanics and biomedical engineering.

[3]  Paul S. Krueger,et al.  The significance of vortex ring formation to the impulse and thrust of a starting jet , 2003 .

[4]  O. Alfieri,et al.  Guidelines on the management of valvular heart disease (version 2012). , 2012, European heart journal.

[5]  F. Dini,et al.  Value of tissue Doppler imaging for risk stratification of patients with chronic systolic heart failure with or without restrictive mitral flow. , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[6]  A J Tajik,et al.  Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician's Rosetta Stone. , 1997, Journal of the American College of Cardiology.

[7]  Marek Belohlavek,et al.  Impact of acute moderate elevation in left ventricular afterload on diastolic transmitral flow efficiency: analysis by vortex formation time. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[8]  David Auerbach,et al.  Stirring properties of vortex rings , 1991 .

[9]  M. Yacoub,et al.  Asymmetric redirection of flow through the heart , 2000, Nature.

[10]  Gianni Pedrizzetti,et al.  On the Left Ventricular Vortex Reversal after Mitral Valve Replacement , 2010, Annals of Biomedical Engineering.

[11]  Arash Kheradvar,et al.  Optimal vortex formation as an index of cardiac health. , 2006, Proceedings of the National Academy of Sciences of the United States of America.

[12]  E. M. Pedersen,et al.  Two-dimensional mitral flow velocity profiles in pig models using epicardial Doppler echocardiography. , 1994, Journal of the American College of Cardiology.

[13]  Maurizio Galderisi,et al.  Diastolic dysfunction and diastolic heart failure: diagnostic, prognostic and therapeutic aspects , 2005, Cardiovascular ultrasound.

[14]  J. Chambers,et al.  Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. , 2009, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[15]  Arash Kheradvar,et al.  The effects of dynamic saddle annulus and leaflet length on transmitral flow pattern and leaflet stress of a bileaflet bioprosthetic mitral valve. , 2012, The Journal of heart valve disease.

[16]  William J van Gaal Dr,et al.  Platypnea-orthodeoxia associated with a fenestrated atrial septal aneurysm: Case Report , 2005 .

[17]  Arash Kheradvar,et al.  On Mitral Valve Dynamics and its Connection to Early Diastolic Flow , 2008, Annals of Biomedical Engineering.

[18]  Pr Alec Vahanian.  Guidelines on the management of valvular heart disease: reply , 2007 .

[19]  B. Howard,et al.  Mitral Ratio of Peak Early to Late Diastolic Filling Velocity as a Predictor of Mortality in Middle-Aged and Elderly Adults: The Strong Heart Study , 2002, Circulation.

[20]  J. De Sutter,et al.  Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E') and the ratio of transmitral early peak velocity to E' (E/E'). , 2005, The American journal of cardiology.

[21]  Robin Shandas,et al.  In vitro and preliminary in vivo validation of echo particle image velocimetry in carotid vascular imaging. , 2011, Ultrasound in medicine & biology.

[22]  A P Yoganathan,et al.  Left ventricular blood flow patterns in normal subjects: a quantitative analysis by three-dimensional magnetic resonance velocity mapping. , 1995, Journal of the American College of Cardiology.

[23]  Gianni Pedrizzetti,et al.  Characterization and quantification of vortex flow in the human left ventricle by contrast echocardiography using vector particle image velocimetry. , 2008, JACC. Cardiovascular imaging.

[24]  Jianwen Wang,et al.  Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. , 2007, European heart journal.

[25]  P. Krueger,et al.  Measurement of ambient fluid entrainment during laminar vortex ring formation , 2008 .

[26]  Randolph P. Martin,et al.  Two-dimensional echocardiographic measurement of left ventricular ejection fraction: prospective analysis of what constitutes an adequate determination. , 1982, American heart journal.

[27]  M. Gharib,et al.  A universal time scale for vortex ring formation , 1998, Journal of Fluid Mechanics.

[28]  S. Khouri,et al.  A practical approach to the echocardiographic evaluation of diastolic function. , 2004, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[29]  Richard B Devereux,et al.  Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardio , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[30]  Paul Linden,et al.  The formation of ‘optimal’ vortex rings, and the efficiency of propulsion devices , 2001, Journal of Fluid Mechanics.

[31]  S. Kovacs,et al.  Vortex formation time-to-left ventricular early rapid filling relation: model-based prediction with echocardiographic validation. , 2010, Journal of applied physiology.

[32]  Douglas W Mahoney,et al.  Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. , 2003, JAMA.

[33]  R. Gibbons,et al.  Guidelines for the Management of Patients With Valvular Heart Disease Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Valvular Heart Disease) , 1998 .

[34]  Arash Kheradvar,et al.  Echocardiographic particle image velocimetry: a novel technique for quantification of left ventricular blood vorticity pattern. , 2010, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[35]  Mahbubul Alam,et al.  Characteristics of left ventricular diastolic function in patients with systolic heart failure: a Doppler tissue imaging study. , 2005, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[36]  J. Dabiri.  Note on the induced Lagrangian drift and added-mass of a vortex , 2006, Journal of Fluid Mechanics.

[37]  R Gorlin,et al.  Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. , 1976, The American journal of cardiology.

[38]  Michele Milano,et al.  Correlation Between Vortex Ring Formation and Mitral Annulus Dynamics During Ventricular Rapid Filling , 2007, ASAIO journal.

[39]  Morteza Gharib,et al.  The role of optimal vortex formation in biological fluid transport , 2005, Proceedings of the Royal Society B: Biological Sciences.

[40]  Helmut Baumgartner,et al.  Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology , 2007 .

[41]  Damien Garcia,et al.  Two-Dimensional Intraventricular Flow Mapping by Digital Processing Conventional Color-Doppler Echocardiography Images , 2010, IEEE Transactions on Medical Imaging.

[42]  Arash Kheradvar,et al.  Influence of Ventricular Pressure Drop on Mitral Annulus Dynamics Through the Process of Vortex Ring Formation , 2007, Annals of Biomedical Engineering.

[43]  A. Heringa,et al.  Normal diastolic filling patterns of the left ventricle. , 1988, European heart journal.

[44]  G. de Simone,et al.  Prognostic significance of left ventricular diastolic dysfunction in essential hypertension. , 2002, Journal of the American College of Cardiology.