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European Journal of Heart Failure 2005 7(1):19-28; doi:10.1016/j.ejheart.2004.03.010
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© 2004 European Society of Cardiology

Colour M-mode velocity propagation: a glance at intra-ventricular pressure gradients and early diastolic ventricular performance

Bart W.L. De Boecka, Jae K. Oha,b, Pieter M. Vandervoorta,c, Jan A. Vierendeelsa,d, Ronald P.L.M. van der Aaa and Maarten-Jan M. Cramera,*

a Division of Cardiology, Heart Lung Centre, University Hospital Utrecht Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
b The Division of Cardiovascular Diseases and Internal Medicine Mayo Clinics and Foundation, Rochester, MN, USA
c The Division of Cardiology Heart Centre Genk, Genk, Belgium
d The Department of Flow, Heat and Combustion Mechanics, Institute Biomedical Technology Ghent University, Ghent, Belgium

* Corresponding author. Tel.: +31-30-250-7260; fax: +31-30-250-5421. E-mail address: m.j.m.cramer{at}hli.azu.nl


  Abstract

The physiology of early-diastolic filling comprises ventricular performance and fluid dynamical principles. Elastic recoil and myocardial relaxation rate determine left ventricular early diastolic performance. The integrity of left ventricular synchrony and geometry is essential to maintain the effect of their timely action on early diastolic left ventricular filling. These factors not only are prime determinants of left ventricular pressure decay during isovolumic relaxation and immediately after mitral valve opening; they also instigate the generation of a sufficient intra-ventricular pressure gradient, which enhances efficient early diastolic left ventricular filling. Accurate assessment of diastolic (dys)function by non-invasive techniques has important therapeutic and prognostic implications but remains a challenge to the cardiologist. The evaluation of left ventricular relaxation by the standard Doppler echocardiographic parameters is hindered by their preload dependency. The colour M-mode velocity propagation of early diastolic inflow (Vp) correlates with intra-ventricular pressure gradients and is a largely preload independent index of ventricular diastolic performance. In this article, the physiologic background, utility and limitations of this promising new tool for the study of early diastolic filling are reviewed.

Key Words: Diastole • Pressure gradients • Echocardiography • Filling pressures

Received October 5, 2003; Revised January 26, 2004; Accepted March 20, 2004


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