Cardiovascular Engineering

, Volume 5, Issue 1, pp 1–12

Frequency-Based Analysis of Diastolic Function: The Early Rapid Filling Phase Generates Negative Intraventricular Wave Reflections

Article

Abstract

To assess global diastolic function (DF), both invasive and noninvasive methods have been utilized. Except for the end-diastolic pressure–volume relationship, currently all proposed parameters for diastolic function are derived purely from pressure or flow. To characterize the physiology of diastole in the context of atrioventricular pressure gradient generated transmitral flow, and in analogy to frequency-based characterization of ventricular–vascular coupling, we subjected the simultaneously recorded transmitral flow (E-wave) and micromanometric intraventricular pressure (LVP) waveforms to Fourier analysis in 20 subjects. This permitted computation of input impedance, characteristic impedance, the phase angle φ relating pressure to flow, and the complex reflection coefficient R* during the E-wave. We found that the magnitudes of input impedance were 32± 12, 13.9± 4.4, 37± 13, and 53± 23 mmHg s/m for DC, 1st, 2nd, and 3rd harmonics, respectively. The characteristic impedance was 30± 15 mmHg s/m. The magnitude and phase angle of complex reflection coefficient R* were 0.43± 0.11 and 3.58± 0.52 rad, respectively. The magnitude of the input impedance carrying most oscillatory power (1st harmonic) is lower than the characteristic impedance, verifying our finding that the real portion of R* was negative. We also found that E waves with prolonged deceleration time (DT > 180 ms—“delayed relaxation” pattern) manifest increased phase differences between pressure and flow, voiding an optimal pressure–flow relationship. These findings elucidate the frequency-based (amplitude/phase) mechanisms by which early diastolic mechanical ventricular suction (dP/dV < 0) achieves left ventricular filling.

Key words

diastolic function Fourier analysis impedance Doppler echocardiography reflection 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Appleton CP, Hatle LK, and Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiography. J Am Coll Cardiol 12: 426–440, 1988.CrossRefGoogle Scholar
  2. Appleton CP, and Hatle LK. The natural history of left ventricular filling abnormalities: Assessment by two-dimensional and Doppler echocardiography. Echocardiography 9: 437–457, 1992.Google Scholar
  3. Caro CG, Pedley TJ, Schroter RC, and Seed WA. The Mechanics of the Circulation. Oxford: Oxford University Press, 1978.Google Scholar
  4. Courtois M, Kovács SJ, and Ludbrook PA. Transmitral pressure–flow velocity relation. Importance of regional pressure gradients in the left ventricle during diastole. Circulation 78: 661–671, 1988.Google Scholar
  5. Dujardin JP, Stone DN, Forcino CD, Paul LT, and Pieper HP. Effects of blood volume changes on characteristic impedance of the pulmonary artery. Am J Physiol 242: H197–H202, 1982.Google Scholar
  6. Eucker SA, Lisauskas J, Courtois MR, and Kovács SJ. Analysis of left ventricular hemodynamics in physiological hyperspace. J Appl Physiol 92: 323–330, 2002.Google Scholar
  7. Hall AF, and Kovács SJ. Automated method for characterization of diastolic transmitral Doppler velocity contours: Early rapid filling. Ultrasound Med Biol 20: 107–116, 1994.Google Scholar
  8. Hollander EH, Wang JJ, Dobson GM, Parker KH, and Tyberg JV. Negative wave reflections in pulmonary arteries. Am J Physiol Heart Circ Physiol 281(2): H895–H902, 2001.Google Scholar
  9. Karamanoglu M, and Kovács SJ. Thermodynamic phase plane analysis of ventricular contraction and relaxation. Biomed Eng Online 3(1): 6, 2004.Google Scholar
  10. Kass DA, Bronzwaer JG, and Paulus WJ. What mechanisms underlie diastolic dysfunction in heart failure? Circ Res 94: 1533–1542, 2004.Google Scholar
  11. Kitzman DW. Diastolic dysfunction in the elderly: Genesis and diagnostic and therapeutic implications. Cardiol Clin 18: 597–620, 2000.Google Scholar
  12. Kovács SJ, Barzilai B, and Pérez JE. Evaluation of diastolic function with Doppler echocardiography: The PDF formalism. Am J Physiol Heart Circ Physiol 252: H178–H187, 1987.Google Scholar
  13. Kovács SJ, Meisner JS, and Yellin EL. Modeling of diastole. Cardiol Clin 18: 459–490, 2000a.Google Scholar
  14. Kovács SJ, Ed. Diastolic function and dysfunction. Cardiol Clin 18: 411–669, 2000b.Google Scholar
  15. Kovács SJ, Jr, McQueen DM, and Peskin CS. Modelling cardiac fluid dynamics and diastolic function. Phil Trans R Soc Lond A 359: 1299–1314, 2001.MATHGoogle Scholar
  16. Little WC, Ohno M, Kitzman DW, Thomas JD, and Cheng CP. Determination of left ventricular chamber stiffness from the time for deceleration of early left ventricular filling. Circulation 92(7): 1933–1939, 1995.Google Scholar
  17. McDonald DA. The relation of pulsatile pressure to flow in arteries. J Physiol 127: 533–552, 1955.Google Scholar
  18. Milde JM, Sessoms MS, Lisauskas JB, Bowman AW, Courtois MR, and Kovács SJ. Ventricular diastolic impedance: A new index of global diastolic function [Abstract]. J Am Coll Cardiol (Suppl) 35(2): 85A, 2000.Google Scholar
  19. Milnor WR. Hemodynamics. Baltimore, MD: Williams & Wilkins, 1982.Google Scholar
  20. Nichols WW, and O’Rourke MF. McDonald’s Blood Flow in Arteries: Theoretical, Experimental and Clinical Principles. New York, NY: Oxford university press, 1998.Google Scholar
  21. Nikolić S, Yellin EL, Tamura K, Vetter H, Tamura T, Meisner JS, and Prater RW. Passive properties of canine left ventricle: Diastolic stiffness and restoring forces. Circ Res 62: 1210–1222, 1988.Google Scholar
  22. Nudelman SP, Hall AF, and Kovács SJ: Comparison of diastolic filling models and their fit to transmitral Doppler contours. Ultrasound Med Biol 21(8): 989–999, 1995.Google Scholar
  23. Parker KH, and Jones CJ. Forward and backward running waves in the arteries: Analysis using the method of characteristics. J Biomech Eng 112: 322–326, 1990.Google Scholar
  24. Quick CM, Berger DS, and Noordergraaf A. Constructive and destructive addition of forward and reflected arterial pulse waves. Am J Physiol Heart Circ Physiol 280: H1519–H1527, 2001.Google Scholar
  25. Sessoms MW, Lisauskas J, and Kovács SJ. The left ventricular color M-mode Doppler flow propagation velocity V(p): In vivo comparison of alternative methods including physiologic implications. J Am Soc Echocardiogr 15(4): 339–348, 2002.Google Scholar
  26. Soto PF, and Kovács SJ. The diagnosis and treatment of diastolic heart failure. Cardiovasc Rev Rep 23: 493–500, 2002.Google Scholar
  27. Sun YH, Anderson TJ, Parker KH, and Tyberg JV. Wave-intensity analysis: A new approach to coronary hemodynamics. J App Physiol 89(4): 1636–1644, 2000.Google Scholar
  28. Vasan RS, and Benjamin EJ. Diastolic heart failure–-no time to relax [Editorial]. N Engl J Med 344: 56–59, 2001.Google Scholar
  29. Womersley JR. Method for the calculation of velocity, rate of flow and viscous drag in arteries when the pressure gradient is known.J Physiol 127: 553–563, 1955a.Google Scholar
  30. Womersley JR. Oscillatory motion of a viscous liquid in a thin-walled elastic tube. I. The linear approximation of long waves. Phil Mag 46: 199–221, 1955b.MATHMathSciNetGoogle Scholar
  31. Zile MR, Gaasch WH, Carroll JD, Feldman MD, Aurigemma GP, Schaer GL, Ghali JK, and Liebson PR. Heart failure with a normal ejection fraction: Is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure? Circulation 104(7): 779–782, 2001.Google Scholar
  32. Zile MR, Baicu CF, and Gaasch WH. Diastolic heart failure–-abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 350: 1953–1959, 2004.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Cardiovascular Biophysics LaboratoryWashington University School of MedicineSt. Louis
  2. 2.Cardiovascular Biophysics LaboratoryWashington University Medical CenterSt. Louis

Personalised recommendations