The International Journal of Cardiovascular Imaging

, Volume 35, Issue 9, pp 1627–1636 | Cite as

Effect of diastolic dysfunction on intraventricular velocity behavior in early diastole by flow mapping

  • Bostjan BerlotEmail author
  • Jose Luis Moya Mur
  • Borut Jug
  • Daniel Rodríguez Muñoz
  • Alicia Megias
  • Eduardo Casas Rojo
  • Covadonga Fernández-Golfín
  • Jose Luis Zamorano
Original Paper


Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We designed our study to compare intraventricular velocities and gradients, obtained by vector flow mapping (VFM) technology during early diastole in consecutive patients diagnosed with mild and advanced diastolic dysfunction at echocardiography and a control group with a purpose to validate the hypothesis of relationship between new parameters and severity of diastolic dysfunction and conventional markers of elevated LV filling pressure. Two-dimensional streamline fields were obtained using VFM technology in 121 subjects (57 with normal diastolic function, 38 with mild diastolic dysfunction and 26 with advanced diastolic dysfunction). We measured several velocities and calculated a gradient along the selected streamline, which we compared between groups and correlated them with conventional echocardiographic parameters. Apical intraventricular velocity gradient (GrIV) was the lowest in control group, followed by mild and advanced diastolic dysfunction groups (5.3 ± 1.9 vs. 6.8 ± 2.5 vs. 13.6 ± 5.0/s, p < 0.001) and showed good correlation with E/e’ (r = 0.751, p < 000.1). GrIV/e’ ratio was the strongest single predictor of severity of diastolic dysfunction. Different degrees of diastolic dysfunction affect the Intraventricular velocity behavior during early diastole obtained by VFM. GrIV could discriminate between groups with different levels of diastolic dysfunction and was closely associated with classical echocardiographic indices of elevated LV filling pressure. GrIV/e’ ratio has a potential to become a single parameter needed to assess left ventricular diastolic function.


Diastolic dysfunction Echocardiography Intraventricular velocity gradient Vector flow mapping Blood flow dynamics 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Flachskampf FA, Biering-Sørensen T, Solomon SD, Duvernoy O, Bjerner T, Smiseth OA (2015) Cardiac imaging to evaluate left ventricular diastolic function. JACC Cardiovasc Imaging 8(9):1071–1093CrossRefPubMedGoogle Scholar
  2. 2.
    Nagueh SF, Smiseth OA, Appleton CP, Byrd BF 3rd, Dokainish H, Edvardsen T et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 29(4):277–314CrossRefPubMedGoogle Scholar
  3. 3.
    Kuwaki H, Takeuchi M, Chien-Chia Wu V, Otani K, Nagata Y, Hayashi A et al (2014) Redefining diastolic dysfunction grading: combination of E/A </=0.75 and deceleration time > 140 ms and E/epsilon’ >/=10. JACC Cardiovasc Imaging 7(8):749–758CrossRefPubMedGoogle Scholar
  4. 4.
    Bella JN, Palmieri V, Roman MJ, Liu JE, Welty TK, Lee ET et al (2002) 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 105(16):1928–1933CrossRefPubMedGoogle Scholar
  5. 5.
    Mogelvang R, Sogaard P, Pedersen SA, Olsen NT, Marott JL, Schnohr P et al (2009) Cardiac dysfunction assessed by echocardiographic tissue Doppler imaging is an independent predictor of mortality in the general population. Circulation 119(20):2679–2685CrossRefPubMedGoogle Scholar
  6. 6.
    Courtois M, Kovacs SJJ, Ludbrook PA (1988) Transmitral pressure-flow velocity relation. Importance of regional pressure gradients in the left ventricle during diastole. Circulation 78(3):661–671CrossRefPubMedGoogle Scholar
  7. 7.
    Steine K, Stugaard M, Smiseth O (2002) Mechanisms of diastolic intraventricular regional pressure differences and flow in the inflow and outflow tracts. J Am Coll Cardiol 40(5):983–990CrossRefPubMedGoogle Scholar
  8. 8.
    Pasipoularides A (2015) Mechanotransduction mechanisms for intraventricular diastolic vortex forces and myocardial deformations: part 1. J Cardiovasc Transl Res 8(1):76–87CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Crandon S, Westenberg JJM, Swoboda PP, Fent GJ, Foley JRJ, Chew PG et al (2018) Impact of age and diastolic function on novel, 4D flow CMR biomarkers of left ventricular blood flow kinetic energy. Sci Rep 8(1):14436CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Yotti R, Bermejo J, Antoranz JC, Desco MM, Cortina C, Rojo-Alvarez JL et al (2005) A noninvasive method for assessing impaired diastolic suction in patients with dilated cardiomyopathy. Circulation 112(19):2921–2929CrossRefPubMedGoogle Scholar
  11. 11.
    Yamamoto K, Masuyama T, Tanouchi J, Naito J, Mano T, Kondo H et al (1995) Intraventricular dispersion of early diastolic filling: a new marker of left ventricular diastolic dysfunction. Am Heart J 129(2):291–299CrossRefPubMedGoogle Scholar
  12. 12.
    Moller JE, Sondergaard E, Seward JB, Appleton CP, Egstrup K (2000) Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. J Am Coll Cardiol 35(2):363–370CrossRefPubMedGoogle Scholar
  13. 13.
    de Knegt MC, Biering-Sorensen T, Sogaard P, Sivertsen J, Jensen JS, Mogelvang R (2014) Concordance and reproducibility between M-mode, tissue Doppler imaging, and two-dimensional strain imaging in the assessment of mitral annular displacement and velocity in patients with various heart conditions. Eur Heart J Cardiovasc Imaging 15(1):62–69CrossRefPubMedGoogle Scholar
  14. 14.
    Itatani K, Okada T, Uejima T, Tanaka T, Ono M, Miyaji K et al (2013) Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys 52:07HF16. CrossRefGoogle Scholar
  15. 15.
    Uejima T, Koike A, Sawada H, Aizawa T, Ohtsuki S, Tanaka M et al (2010) A new echocardiographic method for identifying vortex flow in the left ventricle: numerical validation. Ultrasound Med Biol 36(5):772–788CrossRefPubMedGoogle Scholar
  16. 16.
    Rodevand O, Bjornerheim R, Edvardsen T, Smiseth OA, Ihlen H (1999) Diastolic flow pattern in the normal left ventricle. J Am Soc Echocardiogr 12(6):500–507CrossRefPubMedGoogle Scholar
  17. 17.
    Bellhouse BJ (1972) Fluid mechanics of a model mitral valve and left ventricle. Cardiovasc Res 6(2):199–210CrossRefPubMedGoogle Scholar
  18. 18.
    Martinez-Legazpi P, Bermejo J, Benito Y, Yotti R, Perez Del Villar C, Gonzalez-Mansilla A et al (2014) Contribution of the diastolic vortex ring to left ventricular filling. J Am Coll Cardiol 64(16):1711–1721CrossRefPubMedGoogle Scholar
  19. 19.
    Pasipoularides A, Shu M, Shah A, Tucconi A, Glower DD (2003) RV instantaneous intraventricular diastolic pressure and velocity distributions in normal and volume overload awake dog disease models. Am J Physiol Heart Circ Physiol 285(5):H1956–H1965CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Garg P, Crandon S, Swoboda PP, Fent GJ, Foley JRJ, Chew PG et al (2018) Left ventricular blood flow kinetic energy after myocardial infarction—insights from 4D flow cardiovascular magnetic resonance. J Cardiovasc Magn Reson 20(1):61CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Smiseth OA, Steine K, Sandbaek G, Stugaard M, Gjolberg T (1998) Mechanics of intraventricular filling: study of LV early diastolic pressure gradients and flow velocities. Am J Physiol 275(3):H1062–H1069PubMedGoogle Scholar
  22. 22.
    Kuecherer HF, Muhiudeen IA, Kusumoto FM, Lee E, Moulinier LE, Cahalan MK et al (1990) Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation 82(4):1127–1139CrossRefPubMedGoogle Scholar
  23. 23.
    Zhang W, Shmuylovich L, Kovacs SJ (2010) The E-wave delayed relaxation pattern to LV pressure contour relation: model-based prediction with in vivo validation. Ultrasound Med Biol 36(3):497–511CrossRefPubMedGoogle Scholar
  24. 24.
    Pasipoularides A (2013) Evaluation of right and left ventricular diastolic filling. J Cardiovasc Transl Res 6(4):623–639CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Bostjan Berlot
    • 1
    • 2
    Email author
  • Jose Luis Moya Mur
    • 1
  • Borut Jug
    • 2
  • Daniel Rodríguez Muñoz
    • 1
  • Alicia Megias
    • 1
  • Eduardo Casas Rojo
    • 1
  • Covadonga Fernández-Golfín
    • 1
  • Jose Luis Zamorano
    • 1
  1. 1.Cardiology DepartmentHospital Universitario Ramon y CajalMadridSpain
  2. 2.Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia

Personalised recommendations