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. 1991 Apr;65(4):194–200. doi: 10.1136/hrt.65.4.194

Diastolic disease in left ventricular hypertrophy: comparison of M mode and Doppler echocardiography for the assessment of rapid ventricular filling.

C H Lee 1, J C Hogan 1, D G Gibson 1
PMCID: PMC1024579  PMID: 1827589

Abstract

OBJECTIVE--To investigate possible discrepancies between M mode and Doppler echocardiography in assessing early diastolic filling. DESIGN--Forty seven patients with left ventricular hypertrophy due to aortic stenosis and 26 healthy controls with a similar age range were studied by M mode, Doppler, apexcardiography, and phonocardiography. The patients also underwent cardiac catheterisation. M mode echograms were digitised by a computer. Early diastolic filling in both groups as assessed by the two techniques was compared. SETTING--A tertiary cardiac referral centre with facilities for non-invasive and invasive investigations. SUBJECTS--Patients referred for assessment of aortic stenosis who had left ventricular hypertrophy. MAIN OUTCOME MEASURES--Filling velocities on Doppler and rates of wall thinning and dimension increase on M mode. RESULTS--Digitised M mode indices of diastolic filling (peak wall thinning rate 6.4 (3.0) v 10.0 (3.0) cm/s and peak rate of dimension increase 9.3 (3.3) v 16 (4.5) cm/s) in the patients and controls were consistently different. In contrast, the Doppler A/E ratio and peak E wave velocity were not; they varied widely among patients with left ventricular hypertrophy. In part, this variability was because the Doppler A/E ratio, but not the digitised M mode indices, was very sensitive to the abnormalities of isovolumic relaxation frequently present in left ventricular hypertrophy. The Doppler A/E ratio varied similarly with age in both normal and hypertrophied hearts; in the patients with ventricular hypertrophy the peak rate of dimension increase depended on age only, whereas the thinning rate was independent of age in both the patients and controls. Neither the A/E ratio nor the M mode indices could be related to the left ventricular end diastolic pressure or the peak aortic pressure difference. CONCLUSIONS--When Doppler and M mode techniques are used to assess rapid filling in patients with left ventricular hypertrophy the M mode indices are more consistently abnormal. The two methods measure different aspects of left ventricular diastolic function and should be regarded as complementary rather than interchangeable.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bonow R. O. Noninvasive evaluation of left ventricular diastolic function by radionuclide angiography: limitations and applications. Int J Cardiol. 1984 May;5(5):659–663. doi: 10.1016/0167-5273(84)90181-5. [DOI] [PubMed] [Google Scholar]
  2. Choong C. Y., Abascal V. M., Thomas J. D., Guerrero J. L., McGlew S., Weyman A. E. Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation. 1988 Sep;78(3):672–683. doi: 10.1161/01.cir.78.3.672. [DOI] [PubMed] [Google Scholar]
  3. DeMaria A. N., Neumann A., Schubart P. J., Lee G., Mason D. T. Systematic correlation of cardiac chamber size and ventricular performance determined with echocardiography and alterations in heart rate in normal persons. Am J Cardiol. 1979 Jan;43(1):1–9. doi: 10.1016/0002-9149(79)90036-5. [DOI] [PubMed] [Google Scholar]
  4. Devereux R. B., Reichek N. Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation. 1977 Apr;55(4):613–618. doi: 10.1161/01.cir.55.4.613. [DOI] [PubMed] [Google Scholar]
  5. Gibson D. G., Brown D. J. Measurement of peak rates of left ventricular wall movement in man. Comparison of echocardiography with angiography. Br Heart J. 1975 Jul;37(7):677–683. doi: 10.1136/hrt.37.7.677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gibson D. G., Prewitt T. A., Brown D. J. Analysis of left ventricular wall movement during isovolumic relaxation and its relation to coronary artery disease. Br Heart J. 1976 Oct;38(10):1010–1019. doi: 10.1136/hrt.38.10.1010. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Gibson D. G., Traill T. A., Hall R. J., Brown D. J. Echocardiographic features of secondary left ventricular hypertrophy. Br Heart J. 1979 Jan;41(1):54–59. doi: 10.1136/hrt.41.1.54. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ishida Y., Meisner J. S., Tsujioka K., Gallo J. I., Yoran C., Frater R. W., Yellin E. L. Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure. Circulation. 1986 Jul;74(1):187–196. doi: 10.1161/01.cir.74.1.187. [DOI] [PubMed] [Google Scholar]
  9. Kuo L. C., Quinones M. A., Rokey R., Sartori M., Abinader E. G., Zoghbi W. A. Quantification of atrial contribution to left ventricular filling by pulsed Doppler echocardiography and the effect of age in normal and diseased hearts. Am J Cardiol. 1987 May 1;59(12):1174–1178. doi: 10.1016/0002-9149(87)90870-8. [DOI] [PubMed] [Google Scholar]
  10. Lee C. H., Vancheri F., Josen M. S., Gibson D. G. Discrepancies in the measurement of isovolumic relaxation time: a study comparing M mode and Doppler echocardiography. Br Heart J. 1990 Sep;64(3):214–218. doi: 10.1136/hrt.64.3.214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Miyatake K., Okamoto M., Kinoshita N., Owa M., Nakasone I., Sakakibara H., Nimura Y. Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol. 1984 Feb 1;53(4):586–589. doi: 10.1016/0002-9149(84)90035-3. [DOI] [PubMed] [Google Scholar]
  12. Ng K. S., Gibson D. G. Relation of filling pattern to diastolic function in severe left ventricular disease. Br Heart J. 1990 Apr;63(4):209–214. doi: 10.1136/hrt.63.4.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Park C. H., Chow W. H., Gibson D. G. Phase differences between left ventricular wall motion and transmitral flow in man: evidence for involvement of ventricular restoring forces in normal rapid filling. Int J Cardiol. 1989 Sep;24(3):347–354. doi: 10.1016/0167-5273(89)90014-4. [DOI] [PubMed] [Google Scholar]
  14. Quinones M. A., Gaasch W. H., Waisser E., Alexander J. K. Reduction in the rate of diastolic descent of the mitral valve echogram in patients with altered left ventricular diastolic pressure-volume relations. Circulation. 1974 Feb;49(2):246–254. doi: 10.1161/01.cir.49.2.246. [DOI] [PubMed] [Google Scholar]
  15. Rokey R., Kuo L. C., Zoghbi W. A., Limacher M. C., Quinones M. A. Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: comparison with cineangiography. Circulation. 1985 Mar;71(3):543–550. doi: 10.1161/01.cir.71.3.543. [DOI] [PubMed] [Google Scholar]
  16. Sanderson J. E., Gibson D. G., Brown D. J., Goodwin J. F. Left ventricular filling in hypertrophic cardiomyopathy. An angiographic study. Br Heart J. 1977 Jun;39(6):661–670. doi: 10.1136/hrt.39.6.661. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Upton M. T., Gibson D. G., Brown D. J. Echocardiographic assessment of abnormal left ventricular relaxation in man. Br Heart J. 1976 Oct;38(10):1001–1009. doi: 10.1136/hrt.38.10.1001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Upton M. T., Gibson D. G. The study of left ventricular function from digitized echocardiograms. Prog Cardiovasc Dis. 1978 Mar-Apr;20(5):359–384. doi: 10.1016/0033-0620(78)90003-8. [DOI] [PubMed] [Google Scholar]

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