Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography.

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Abstract
The relationship between Doppler-derived flow velocity through the mitral anulus and angiographic parameters of left ventricular filling was determined by 30 patients studied by 2-dimensional echocardiography combined with pulsed Doppler echocardiography followed within 1 h by left ventricular angiography. The average heart rate for each test was 69 beats/min. Doppler-derived parameters included: early peak diastolic velocity (E) and peak atrial velocity, peak filling rate computed as E .times. cross-sectional area of the mitral anulus derived from the annular diameter, normalized peak filling rate computed as peak filling rate divided by the left ventricular end-diastolic volume determined by 2-dimensional echocardiography, and half filling fraction derived from the time-velocity integral of the Doppler-determined velocity curve. Frame-by-frame left ventricular volumes were obtained throughout diastole from single-plant cineangiograms. A volume-time curve with its derivative was generated by computer processing from which peak filling rate, normalized peak filling rate and half filling fraction were measured. Morphologically, the Doppler-derived velocity profile resembled the derivative of the angiographic volume curve. In patients with reduced angiographic peak filling rates, early peak diastolic velocity was often decreased < 45 cm/s with a relative increase in peak atrial velocity resulting in an early peak diastolic velocity to peak atrial velocity ratio < 1.0. There were no significant differences in mean values for peak filling rate, normalized peak filling rate and half filling fraction by Doppler echocardiography vs. angiography (296 vs. 283 ml/s, 1.9 vs. 2.0 s-1 and 0.55 vs. 0.55, respectively). A significant correlation was observed between Doppler echocardiographic and angiographic peak filling rate (r = 0.87, SEE [standard error of the estimate] = 91.5 ml/s) and between Doppler and angiographic normalized peak filling rate (r = 0.83, SEE = 0.52 s-1). The correlation between early peak diastolic velocity and angiographic peak filling rate was significant but with a lower r value (0.64). Doppler measurements of half filling fraction or early peak diastolic velocity to peak atrial velocity ratio correlated with angiographic parameters but this was predominantly true for a subgroup of 15 patients with similar diastolic filling periods during both tests (range of r values 0.71-0.85). These findings validate the use of Doppler measurements of mitral inflow velocities in the noninvasive assessment of left ventricular filling dynamics.