Clinical Investigation
Ventricular Mechanics
Noninvasive Estimation of Left Ventricular Compliance Using Three-Dimensional Echocardiography

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Background

Left ventricular (LV) compliance is an important determinant of LV function and can be affected by a variety of cardiovascular conditions. In particular, diastolic dysfunction is associated with altered LV compliance. However, the evaluation of LV compliance is complex. Although the end-diastolic pressure-volume relationship (EDPVR) allows a direct, accurate evaluation of LV compliance, it requires invasive measurements. The aim of this study was to test the feasibility of noninvasive estimation of the EDPVR as a tool to evaluate LV compliance using three-dimensional echocardiography.

Methods

Sixty-eight subjects were studied, including 23 normal controls, 22 patients with increased LV compliance due to dilated cardiomyopathy, and 23 patients with reduced LV compliance secondary to isolated diastolic dysfunction as defined using current American Society of Echocardiography guidelines. The EDPVR was calculated for each subject using a nonlinear model with echocardiographic estimates of end-diastolic pressure and volume. For both the isolated diastolic dysfunction and dilated cardiomyopathy groups, predicted end-diastolic volumes at predetermined pressure values (5, 10, 20, and 30 mm Hg) were compared with values in normal controls.

Results

Compared with controls, noninvasive estimates of the EDPVR resulted in predicted end-diastolic volumes that were lower in the isolated diastolic dysfunction group and higher in the dilated cardiomyopathy group (P < .0001 for all four pressure levels). In addition, a stepwise trend of decreased compliance was noted for the different grades of diastolic dysfunction.

Conclusions

This is the first study to demonstrate the feasibility of noninvasive estimation of the LV EDPVR and its ability to differentiate normal from abnormal LV compliance using three-dimensional echocardiography.

Section snippets

Participants

After the exclusion of eight subjects with inadequate echocardiographic images, we studied a total of 68 subjects who were ≥18 years of age. The normal control group consisted of 23 subjects with LV end-diastolic volumes (EDVs) < 140 mL, ejection fractions > 55%, and no diastolic dysfunction using current ASE guidelines.1 The reduced LV compliance group included 23 patients with isolated diastolic dysfunction (IDD), which was defined as diastolic dysfunction according to ASE guidelines with

Results

LV EDP calculated using both formulas (Lam et al.12 and Olariu et al.13) showed that both groups of patients had the same mean values, which were significantly different from those of controls (Table 1). Of note, however, LV EDP values in the normal controls were slightly lower when calculated using Lam et al.’s formula.

Figure 3 shows EDPVR curves calculated for the three groups using median values of α and β. These curves represent predicted EDP for any EDV. Compared with the control group,

Discussion

The recently published ASE guidelines have established a framework for determining the presence and severity of diastolic dysfunction and thus made a major contribution to the understanding of this complex and clinically important condition. Nevertheless, there are a considerable number of patients who are difficult to classify (34% in our study), because the simultaneous use of multiple criteria results in discordant conclusions. These patients require expert adjudication that is based on

Conclusions

This is the first study to demonstrate the feasibility of noninvasive estimation of the LV EDPVR using echocardiographic measurements and its ability to differentiate normal from abnormal LV compliance. If confirmed in larger groups of patients with different degrees of diastolic dysfunction, our findings could potentially provide the basis for a valuable adjunct to the conventional methodology for the evaluation of diastolic dysfunction, especially in patients who are difficult to classify

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    Dr. Gayat is a recipient of a research grant from Fondation Pour la Recherche Medicale (Paris, France). Dr. Yodwut received a fellowship from the Department of Medicine, Ramathibodi Hospital, Mahidol University (Bangkok Thailand).

    Richard E. Kerber, MD served as guest editor on this paper.

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