© 2008 European Society of Cardiology
Stratification of impaired relaxation filling patterns by passive leg lifting in patients with preserved left ventricular ejection fraction
a Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
b Ibaraki Medical Center Japan
* Corresponding author. Tel.: +81 29 853 3142; fax: +81 29 853 3143. E-mail address: yo-seo{at}md.tsukuba.ac.jp (Y. Seo)
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Abstract |
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Methods: We evaluated diastolic functional reserve in 108 patients with normal left ventricular ejection fraction (LVEF) 
50% but abnormal relaxation (ratio of transmitral peak velocity of early and late diastolic flow (E/A)<1) using passive leg lifting. We calculated the pulmonary venous systolic to diastolic flow ratio (S/D) as a marker of left atrial reservoir function, and the time difference between the duration of pulmonary venous retrograde flow (PVAd) and the duration of the mitral A wave (PVAd-Ad) as a marker of left ventricular end-diastolic pressure (LVEDP).
Results: During leg lifting, the E/A was 1 in 39 patients (the inverted group); the remaining 69 patients comprised the stable group. Comparing the inverted group with the stable group at baseline, S/D was smaller (1.5±0.4 vs. 1.8±0.5, P=0.002) and PVAd-Ad greater (11±23 ms vs. –23±28 ms, P<0.001).Multiple logistic regression analysis revealed that PVAd-Ad and S/D predicted E/A inversion with leg lifting after adjustment for age, LV wall thickness, LV dimension, LVEF, deceleration time of E, and E/E'.
Conclusion: In patients with preserved LVEF but early diastolic dysfunction, passive leg lifting may identify patients having a less compliant left ventricle and impaired left atrial reservoir function.
Key Words: Left ventricular dysfunction • Diastolic heart failure • Echocardiography • Diastolic functional reserve
Received November 23, 2007; Revised May 20, 2008; Accepted July 21, 2008