Clinical InvestigationVentricular MechanicsNoninvasive Estimation of Left Ventricular 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
References (24)
- et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography
J Am Soc Echocardiogr
(2009) - et al.
Restrictive filling pattern is a powerful predictor of heart failure events postacute myocardial infarction and in established heart failure: a literature-based meta-analysis
J Card Fail
(2007) - et al.
Effect of recommendations on interobserver consistency of diastolic function evaluation
JACC Cardiovasc Imaging
(2011) - et al.
Association of the fourth heart sound with increased left ventricular end-diastolic stiffness
J Card Fail
(2008) - et al.
Usefulness of new diastolic strain and strain rate indexes for the estimation of left ventricular filling pressure
Am J Cardiol
(2008) - et al.
Pulmonary venous flow by Doppler echocardiography: revisited 12 years later
J Am Coll Cardiol
(2003) - et al.
How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the heart failure and echocardiography associations of the european society of cardiology
Eur Heart J
(2007) - 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
Circulation
(2002) - et al.
Ventricular pressure-volume relations as the primary basis for evaluation of cardiac mechanics. Return to Frank's diagram
Basic Res Cardiol
(1989) Asymptotic slope of log pressure vs log volume as an approximate index of the diastolic elastic properties of the myocardium in man
Circulation
(1976)
Comparison of measures of left ventricular contractile performance derived from pressure-volume loops in conscious dogs
Circulation
Simultaneous conductance catheter and dimension assessment of left ventricle volume in the intact animal
Circulation
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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.