Chamber properties from transmitral flow: prediction of average and passive left ventricular diastolic stiffness

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Abstract
A chamber stiffness ( KLV)-transmitral flow (E-wave) deceleration time relation has been invasively validated in dogs with the use of average stiffness [(ΔP/ΔV)avg]. KLVis equivalent to kE, the (E-wave) stiffness of the parameterized diastolic filling model. Prediction and validation of 1) (ΔP/ΔV)avgin terms of kE, 2) early rapid-filling stiffness [(ΔP/ΔV)E] in terms of kE, and 3) passive (postdiastasis) chamber stiffness [(ΔP/ΔV)PD] from A waves in terms of the stiffness parameter for the Doppler A wave ( kA) have not been achieved. Simultaneous micromanometric left ventricular (LV) pressure (LVP) and transmitral flow from 131 subjects were analyzed. (ΔP)avgand (ΔV)avgutilized the minimum LVP-LV end-diastolic pressure interval. (ΔP/ΔV)Eutilized ΔP and ΔV from minimum LVP to E-wave termination. (ΔP/ΔV)PDutilized atrial systolic ΔP and ΔV. E- and A-wave analysis generated kEand kA. For all subjects, noninvasive-invasive relations yielded the following equations: kE= 1,401 · (ΔP/ΔV)avg+ 59.2 ( r = 0.84) and kE= 229.0 · (ΔP/ΔV)E+ 112 ( r= 0.80). For subjects with diastasis ( n = 113), kA= 1,640 · (ΔP/ΔV)PD− 8.40 ( r = 0.89). As predicted, kAshowed excellent correlation with (ΔP/ΔV)PD; kEcorrelated highly with (ΔP/ΔV)avg. In vivo validation of average, early, and passive chamber stiffness facilitates quantitative, noninvasive diastolic function assessment from transmitral flow.