Assessment of Transmitral Vortex Formation in Patients with Diastolic Dysfunction

Kheradvar, Arash; Assadi, Ramin; Falahatpisheh, Ahmad; Sengupta, Partho P.

doi:10.1016/j.echo.2011.10.003

« Previous Next »Journal of the American Society of Echocardiography
Volume 25, Issue 2 , Pages 220-227, February 2012

Assessment of Transmitral Vortex Formation in Patients with Diastolic Dysfunction

Arash Kheradvar, MD, PhD
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, California
- Department of Biomedical Engineering, University of California, Irvine, Irvine, California
- Department of Mechanical and Aerospace Engineering , University of California, Irvine, Irvine, California
- Reprint requests: Arash Kheradvar, MD, PhD, The Edwards Lifesciences Center for Advanced Cardiovascular Technology, Department of Biomedical Engineering, 24010 Engineering Hall, University of California, Irvine, Irvine, CA 92697.
Ramin Assadi, MD
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California
Ahmad Falahatpisheh, MSc
- The Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California, Irvine, Irvine, California
- Department of Mechanical and Aerospace Engineering , University of California, Irvine, Irvine, California
Partho P. Sengupta, MD, DM, FASE
- Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Heart, New York, New York

published online 18 November 2011.

Background

Previous experimental models have related transmitral vortex formation to the longitudinal recoil of left ventricle. However, little is known about the relationships among left ventricular (LV) longitudinal relaxation, transmitral filling patterns, and LV vortex formation in clinical settings. The aim of this study was to compare the vortex formation time index among a heterogeneous group of patients with diastolic dysfunction to understand the relationship between transmitral vortex formation and abnormal diastolic filling patterns.

Methods

Echocardiographic data from 107 subjects were retrospectively evaluated. The study population was categorized into four groups on the basis of transmitral early and late diastolic Doppler filling patterns as normal (n = 45), impaired relaxation (n = 14), pseudonormal (n = 26), and restrictive (n = 22). Vortex formation time was computed from the governing equations based on transmitral flow and ejection fraction.

Results

Differences in vortex formation time index were found to be significant among all the studied groups (P < .0001). The trend of vortex formation during a cardiac cycle was compared in normal hearts and those with diastolic dysfunction. Mitral annular velocity (e′) was found to decrease significantly (P < .0001) in subjects with abnormal transmitral filling patterns compared with normal subjects. The difference in e′ among all the affected groups was not found to be significant (P = .68).

Conclusions

The findings of this study suggest that patients with different patterns of transmitral diastolic filling show significant changes in LV vortex formation time despite the absence of significant differences in mitral annulus recoil during diastole.

Keywords: Vortex formation time, Transmitral filling pattern, Diastolic dysfunction, Transmitral vortex, Cardiac fluid dynamics

Abbreviations: ANOVA, Analysis of variance, EF, Ejection fraction, LA, Left atrium, LAVI, Left atrial volume index, LV, Left ventricle, LVEDV, Left ventricular end-diastolic volume, VFT, Vortex formation time