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Background There is a lack of comprehensive echocardiographic data to allow discrimination of normal versus abnormal mechanical prosthetic tricuspid valve (MPTV) leaflet function. The identification of such parameters is essential to optimize diagnostic and therapeutic measures. Methods The authors investigated bileaflet MPTV function by comparing transthoracic echocardiographic data from 21 episodes of leaflet dysfunction due to valve thrombosis in 12 patients with data from 56 individuals with normal MPTV function. All episodes of dysfunction were confirmed by transesophageal echocardiography and/or cine fluoroscopy. Transthoracic echocardiography–derived two-dimensional, color, and spectral Doppler variables, including MPTV peak early diastolic velocity (E velocity), mean gradient, pressure half-time, time-velocity integral (TVI) of the MPTV, ratio of TVIMPTV to TVI of the left ventricular outflow tract (LVOT) and TVI of the right ventricular outflow tract (RVOT), and continuity-derived effective orifice area, were measured in both groups. Results Most episodes of MPTV dysfunction resulted from simultaneous involvement of both leaflets (57%), with leaflet(s) often immobilized in the open or semiopen position (71%). Transthoracic and transesophageal echocardiography performed similarly in detecting abnormal leaflet motion (90% vs 88%, P = .68), whereas transesophageal echocardiography was better in identifying MPTV thrombosis (31% vs 14%, respectively, P = .01). Color Doppler demonstrated flow propagation abnormalities in 67% of episodes of leaflet dysfunction but not in the control group (P 1.6 m/sec, mean gradient > 5 mm Hg, PHT > 157 msec, TVIMPTV > 42 cm, TVIMPTV/TVILVOT > 2.3, TVIMPTV/TVIRVOT > 3.0, and continuity-derived effective orifice area ≤ 1.1 cm2, with most variables showing high and similar accuracy (area under the curve ≥ 95%). Conclusions This study represents the first comprehensive echocardiographic assessment of MPTV leaflet dysfunction that provides parameters and criteria to distinguish normal versus abnormal prosthetic valve function.

Objective: Diastolic dysfunction precedes systolic dysfunction during the development of myocardial ischemia. Detecting diastolic dysfunction during stress test for coronary artery disease (CAD) could improve diagnostic sensitivity of the test. Flow propagation velocity (FPV) derived from color M-mode Doppler has been proposed as a sensitive marker to detect diastolic dysfunction. Methods: The FPVs at baseline and at peak dobutamine infusion were measured using color M-mode Doppler during dobutamine stress echocardiography in 90 patients. The results are compared among the groups divided on the results of coronary angiography. Results: The FPV was similar at baseline among the groups. At peak dobutamine infusion, the FPV increased significantly in the non-CAD group (from 56 ± 19 cm/s to 66 ± 25 cm/s), whereas it failed to increase in the groups with CAD. As a result, the peak FPV was significantly lower in the groups with CAD than in the non-CAD group. Receiver operating characteristic analysis showed that the peak FPV and ΔFPV had good diagnostic property to detect CAD (the areas under the curves were 0.77 and 0.73, respectively). Adopting these FPV criteria, sensitivity of DSE was improved. Conclusion: FPV measurement during DSE detects ischemic left ventricular diastolic dysfunction. Adding the assessment of peak FPV to conventional DSE increases the sensitivity and the ability to reliably exclude CAD. (Echocardiography 2011;28:335-341)

OBJECTIVE This study investigates the change in flow propagation velocity (FPV) in uremic patients who undergo regular hemodialysis (H/D). MATERIALS AND METHODS We studied 93 uremic patients (44 men and 49 women; 59 +/- 14-years-old) receiving regular hemodialysis. Patients were separated by baseline left ventricular ejection fraction (LVEF): 71 patients with LVEF > 50% (group 1), 13 patients with LVEF 35-50% (group 2), 7 patients with LVEF 50%, FPV after H/D was almost always lower, regardless of H/D amount. But there was different response in patients with baseline LVEF 50%.

To test the applicability of isovolumic relaxation flow propagation velocity (IRFPV) as an indicator of relaxation, 38 patients undergoing cardiac catheterization for chest pain were included. The time constant of isovolumic left ventricular (LV) pressure decline (tau) had a significant correlation with the LV end-diastolic pressure, the peak negative dp/dt, the LV end-diastolic dimension, the fractional shortening, the late diastolic transmitral flow velocity, the early and late diastolic mitral annular velocities, the rapid filling flow propagation velocity, and the natural logarithms of heart rate, ejection fraction, LV end-systolic dimension and IRFPV (r = -0.773, p0.001). IRFPV was selected as the major independent determinant of tau, explaining 46% of its variance. In prediction of tauor =42 ms, the sensitivity and specificity were 100% and 83% for IRFPVor =104 cm/s, 77% and 67% for the rapid filling flow propagation velocityor =50 cm/s, and 58% and 67% for the early diastolic mitral annular velocityor =8 cm/s, respectively. In conclusion, our data suggest that IRFPV could be a better marker of LV relaxation than other parameters, as the rapid filling flow propagation velocity or the early diastolic mitral annular velocity.

OBJECTIVE We aimed to evaluate myocardial diastolic function in patients with beta-thalassemia major (beta-TM) using pulsed-tissue Doppler imaging (TDI) and flow propagation (VP), in relation to BNP levels. METHODS We enrolled 192 consecutive patients with beta-TM (88 men (25 +/- 6 years) and 104 women (26 +/- 6 years), with normal left ventricular (LV) systolic function. By TDI, diastolic myocardial velocities were sampled at the lateral section of the mitral annulus (Smv, Emv, Amv). From the apical four-chamber view diastolic transmitral flow velocities, including measures of E- and A-waves were performed. The propagation velocity of early flow into the LV cavity was measured by color M-mode Doppler. Plasma BNP levels were measured in all patients. RESULTS A nonlinear relationship was found between BNP levels and E/A ratio (beta coefficient for the second-order term = 1.4 +/- 0.4, P = 0.001). We also found a positive association of BNP levels with Amv (r = 0.28, P = 0.023), and a reverse with Smv (r =-0.59, P = 0.01) and Emv/Amv (r =-0.36, P = 0.019). Moreover, an inverse relationship was observed between BNP and Vp (r =-0.43, P = 0.012) levels. Finally, a strong positive linear relationship was found between E/Vp ratio and BNP levels (r = 0.76, P < 0.001). CONCLUSION A U-curved association of E/A ratio of transmitral Doppler velocity was revealed with BNP levels, while the tissue Doppler of the Emv/Amv of the mitral annulus movement showed a negative linear association with BNP levels.

Objective This study investigated the change in new diastolic indexes in patients with uremia who undergo regular hemodialysis (H/D). Methods We studied 81 patients with uremia (41 men and 40 women) receiving regular H/D. All patients were in sinus rhythm before H/D. They had normal left ventricular systolic performance without regional wall-motion abnormality. Three patients were excluded because of atrial fibrillation after H/D. Patients were separated by the amount of body fluid removed during H/D procedure: 30 patients with H/D amount less than 2 kg (group 1), 33 patients with H/D amount between 2 and 3 kg (group 2), and 18 patients with H/D amount larger than 3 kg (group 3). They received complete transthoracic echocardiographic examinations. Flow propagation velocity (FPV) was measured by color M-mode echocardiography in apical 4-chamber view. Mitral annulus Doppler tissue velocities (peak systolic [Sa], early diastolic [Ea], and late diastolic [Aa]) were measured from septal, lateral, inferior, and posterior walls. All these parameters were obtained immediately before and after H/D. Paired data were compared. Results In patients with removed fluid amount less than 2 kg (group 1), the change of all diastolic parameters showed insignificant change except FPV (peak mitral E, P = .14; peak mitral A, P = .916; FPV, P = .009; septal Sa, P = .173; septal Ea, P = .295; septal Aa, P = .649). In patients with H/D amount between 2 and 3 kg, the change of all diastolic parameters showed statistically significant difference except Sa (peak mitral E, P = .001; peak mitral A, P = .001; FPV, P = .001; Sa, P = .589; Ea, P = .001; Aa, P = .015). In patients with H/D amount larger than 3 kg, Sa still showed insignificant change. Ea, Aa, and FPV showed significant difference after H/D (peak mitral E, P = .001; peak mitral A, P = .035; FPV, P = .008; septal Sa, P = .777; septal Ea, P = .014; septal Aa, P = .048). Conclusion In patients with normal left ventricular systolic function, FPV was preload dependent. Diastolic phase mitral annulus Doppler tissue velocities (Ea and Aa) behaved differently according to the amount removed during H/D. They were preload independent when the amount removed during H/D was less than 2 kg. When the amount removed during H/D was larger than 2 kg, diastolic phase mitral annulus Doppler tissue velocities changed significantly. That is to say, diastolic phase mitral annulus Doppler tissue velocities were not totally preload independent. For systolic phase mitral annulus Doppler tissue velocity index (Sa), it was preload independent.

Background and objective: Color M-mode flow propagation velocity (Vp) was shown to be a preload-independent measure of diastolic function. To study the effects of an increase in afterload induced by isometric handgrip exercise on diastolic function assessment in patients with cardiomyopathy, we measured Vp and conventional Doppler indices at baseline and at 30% of predetermined maximum handgrip strength. Methods: Twenty-four patients with systolic dysfunction were divided into two groups: Group I comprising 12 patients with E/A 1. All the patients underwent measurement of Vp, E velocity, its deceleration time (DT), A velocity, isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) at baseline and at 30% of predetermined maximum handgrip strength. Twelve healthy controls underwent these same measurements. Results: When comparing baseline to peak echocardiographic data, no significant changes were noted in Vp in any of the groups while a shift of pulsed Doppler indices of Group I toward a pattern closer to that of Group II was noted and a decrease in E velocity and E/A ratio with an increase in IVRT occurred in healthy controls. Conclusions: Color M-mode flow propagation velocity seems to be an afterload-independent measure of diastolic function in patients with moderate to severe cardiomyopathy while pulsed Doppler indices are more sensitive to loading conditions induced by isometric exercise.

Pulsed wave tissue Doppler echocardiography (PW-TDE) and color M-mode are new Doppler methods for left ventricular (LV) diastolic function assessment. To date, few studies have compared the data obtained by these methods in the same series of patients and compared them to the current clinical reference method of detecting LV diastolic function.To determine the utility of PW-TDE and color M-mode parameters in the assessment of LV diastolic function in the typical patient population encountered in daily clinical practice and to compare their discriminating power.Early diastolic septal mitral annular velocity (Em) determined by PW-TDE and color M-mode flow propagation velocity (Vp) were measured in 86 male patients and compared to LV filling patterns obtained using standard Doppler indices. Values of Em0.08 m s(-1) and Vp0.5 m s(-1) were considered as markers of abnormal LV diastolic function.A value of Em0.08 m s(-1) distinguished mild to moderate LV diastolic dysfunction with higher sensitivity and specificity than Vp0.5 m s(-1) (96% and 87% vs. 73% and 84%, respectively). A comparison of receiver operating characteristic curves showed a significant difference for areas under the curve in favor of Em (P0.01). In a stepwise multiple logistic regression analysis, a pseudonormal filling pattern and an EF60% were identified as significant predictors of Vp false negative results (p0.05).Em appears to be superior to Vp in the detection of mild to moderate LV diastolic dysfunction. Vp failed to detect abnormal LV diastolic function in particular in patients with preserved LV systolic function and a pseudonormal filling pattern type.

Echocardiographic Doppler methods widely used in assessment of the severity of aortic regurgitation (AR) are considered sensitive and reliable. However, they all have limitations for quantitation of AR. The color M-mode Doppler flow propagation velocity (FPV) method has been shown to provide useful insights in the evaluation of left ventricular diastolic function and appears to be minimally affected with preload changes. Clinical data regarding the value of FPV in the determination of the significance of valvular insuffiencies are lacking. The purpose of this study was to evaluate the use of FPV in measurement of the severity of AR and to compare its reliability with angiography and other echocardiographic methods.Twenty-nine patients (13 male, 16 female) who had cardiac catheterization for various reasons before echocardiographic evaluation were included. The mean age was 53.6 +/- 13.4 years. At the time of cardiac catheterization, the degree of AR was assessed as mild in 10 patients, as moderate in 12, and as severe in 7. In all patients, FPV measurements of AR were obtained with color M-mode Doppler in the apical 5-chamber view. Regurgitation jet height and its ratio to left ventricular outflow obtained in the parasternal long axis with color flow Doppler, pressure half-time, and slope of AR obtained with continuous wave Doppler in apical 5-chamber view were other echocardiographic methods chosen for comparison.The mean values of FPV were 93.1 +/- 18.4 cm/s, 49.8 +/- 8.0 cm/s, and 31.7 +/- 4.9 cm/s in severe, moderate, and mild AR groups, respectively (P.001). Significant correlation was observed between angiographic grades, FPV, pressure half-time, slope, and jet height and ratio to left ventricular outflow (P.0001, r = 0.93; P.0001, r = -0.81; P.0001, r = 0.76; P.0001, r = 0.92, respectively).FPV is a simple, practical, and reliable method for the quantification of AR.

Background and Objective: Color M-mode flow propagation velocity (Vp) has been reported as a preload-independent measure of diastolic function. To study the effects of loading conditions on diastolic function assessment in patients on chronic hemodialysis, we measured Vp and conventional Doppler indices pre- and posthemodialysis. Methods: Twenty hemodialysis patients with normal systolic function underwent measurement of Vp, early filling velocity (E), its deceleration time (DT), atrial contraction velocity (A), isovolumic relaxation time (IVRT), and pulmonary atrial flow reversal velocity (PFR) pre- and posthemodialysis. Twelve healthy controls underwent these same measurements. Results: Hemodialysis patients had significantly slower Vp at baseline than normal controls, while E/A, DT, IVRT, and pulmonary flow reversal were not significantly different. E, IVRT, and PFR were affected by hemodialysis, while color M-mode flow propagation velocities, A, and DT were not. Conclusions: Color M-mode flow propagation velocity seems to be a preload-independent measure of diastolic function in chronic hemodialysis patients in whom isolated diastolic dysfunction appears prevalent.

Blood flow throughout the cardiovascular system is governed by the Navier-Stokes equations, a set of 4 coupled 4-dimensional (3 of space and 1 of time) partial differential equations. Although these are impossibly complex to solve analytically or even with the most powerful supercomputers, there are

Flow propagation velocity is a new color Doppler M-mode measurement of left ventricular filling characteristics. This study was designed to establish normal values for this measurement in healthy individuals and to compare these findings with pulsed Doppler transmitral velocities. Complete M-mode, two-dimensional, and Doppler echocardiographic studies were performed on 64 volunteers between 21 and 79 years of age. Significant negative correlations (p < 0.001) with age were noted for flow propagation velocity (r = -0.59), peak early diastolic filling velocity (r = -0.65), and peak early diastolic filling/peak atrial filling ratio (r = -0.80). Positive correlations (p < 0.001) with age were observed for peak atrial filling velocity (r = 0.50) and atrial filling velocity integral (r = 0.71). Flow propagation velocity decreased by 44% between the youngest and oldest age groups. We conclude that flow propagation velocity is influenced by age and that it compares favorably with transmitral Doppler indices of left ventricular filling in this regard. These age-related alterations are present in healthy individuals, in the absence of any apparent cardiovascular disease.

Aims: Early diastolic mitral annular velocity (e') obtained by tissue Doppler imaging (TDI) is widely used to evaluate left ventricular (LV) diastolic function based on the assumption that it reflects myocardial relaxation in the long-axis direction. In this study, we aimed to determine whether or not e' truly reflects early diastolic longitudinal myocardial relaxation, and which is the most useful for evaluating LV diastolic function among e' measured at the interventricular-septal annulus (IS-e'), that measured at the lateral annulus (LW-e') or their mean value (M-e'). Methods and results: IS-e', LW-e', and M-e' were measured using colour TDI in 15 patients with hypertrophic cardiomyopathy, 13 patients with hypertension and 19 control subjects. Using two-dimensional speckle tracking imaging, early diastolic myocardial strain rates (SR_[E]) were measured for the IS (IS-SR_[E]), LW(LW-SR_[E]) and entire LV myocardium (G-SR_[E]). IS-e' was excellently correlated with IS-SR_[E] (r = 0.90, P < 0.001); the correlation was better than that between LW-e' and LW-SR_[E] (r = 0.75, P < 0.001). IS-e' and M-e' were well correlated with G-SR_[E] (r = 0.88, P < 0.001 and r = 0.86, P < 0.001, respectively) and with LV early diastolic flow propagation velocity (r = 0.77, P < 0.001 and r = 0.78, P < 0.001, respectively). The correlations of LW-e' to G-SR_[E] (r = 0.80, P < 0.001) and flow propagation velocity (r = 0.75, P < 0.001) did not reach this level. Conclusion: IS-e' well reflected LV longitudinal myocardial relaxation and LV diastolic function, and was found to be more useful in evaluating LV diastolic function than LW-e'.

To assess the feasibility of left atrial flow propagation velocity (LAFPV) measurement and to evaluate the influence of preload alterations on this new parameter of left atrial (LA) reservoir function as compared to conventional echocardiographic indices. 30 healthy volunteers (26 ± 5 years, 20 males) underwent echocardiographic examination at rest, during passive leg lifting and after sublingual administration of nitroglycerine with subsequent Valsalva maneuver. LA reservoir function was assessed by conventional indices including LA expansion index, peak velocity and velocity-time integral of pulmonary venous systolic flow. As well, LAFPV was measured by color M-mode in an apical 4-chamber view as the slope of the transatrial flow wave during LA reservoir phase. LAFPV measurement was feasible in 25 subjects (83%). All conventional parameters of LA reservoir function were significantly altered from resting values by both load-modifying conditions. However, LAPFV was not significantly altered by such maneuvers (228 ± 28 cm s−1 at rest vs. 238 ± 33 cm s−1 during leg lifting, P = NS, vs. 218 ± 38 cm s−1 after nitroglycerin with Valsalva maneuver, P = NS vs. rest, P

Flow propagation refers to the delay in the onset of blood flow during early filling at more apical ventricular locations. The velocity of flow propagation (Vp) into the left ventricle (LV) provides a preload insensitive estimate of LV relaxation, confirmed invasively by a strong negative correlation with the relaxation time constant (tau) [1, 2]. Clinically, Vp < 50 ms is commonly taken as evidence of abnormal diastolic function. No direct physical relationship between muscle relaxation and flow propagation has been previously illustrated. By simultaneous measurement of myocardial mechanics (radial expansion) and blood patterns throughout the LV and during early filling we expect to illustrate a correlated spatial and temporal relationship between the mechanics which drive blood flow and the resulting blood flow patterns.

Transmitral E wave velocity was reported to be positively related to left ventricular (LV) filling pressure and negatively related to LV relaxation constant, and isovolumic relaxation flow propagation velocity (IRFPV) was proven recently to be negatively related to LV relaxation constant and independent of preload alterations. Therefore, the combination index, E/IRFPV, may eliminate the influence of LV relaxation and bring the LV filling pressure into focus. However, it is unknown whether E/IRFPV is a useful index in prediction of LV filling pressure. The aim of this study is to evaluate the correlation between E/IRFPV and LV end-diastolic pressure (LVEDP). Forty-three patients with suspected coronary artery disease who underwent a Doppler echocardiographic study and cardiac catheterization were included. LVEDP was determined by a micromanometer-tipped catheter. In a univariate analysis, LVEDP had a positive correlation with left atrial dimension, LV end-diastolic dimension, LV end-systolic dimension, the ratio of E to E wave propagation velocity (EPV) (r = 0.408, p = 0.007), the ratio of E to early diastolic mitral annular velocity (Ea) (r = 0.439, p = 0.003) and E/IRFPV (r = 0.686, p0.001). It had a negative correlation with diastolic blood pressure, E wave deceleration time, LV ejection fraction, EPV, Ea and IRFPV. After stepwise multiple linear regression analysis, only the E/IRFPV was the independent predictor of LVEDP (beta = 0.667, p0.001). In conclusion, E/IRFPV is a useful parameter in prediction of LVEDP.

The aim of this study is to evaluate whether isovolumic relaxation flow propagation velocity (IRFPV), a newly proposed relaxation parameter, is independent of load alterations. Thirty-nine uremic patients (21 men; age 62 ± 10 y) who underwent echocardiography 1 h before and 1 h after hemodialysis (HD) were included. After HD, body weight, systolic blood pressure, early transmitral filling wave velocity (E), early diastolic mitral annular velocity (Ea) and early diastolic inflow propagation velocity (EPV) decreased significantly ( p ≤ 0.007), while IRFPV kept constant ( p = 0.550). A subgroup analysis showed that in patients with body weight reduction p = 0.005) decreased significantly, but Ea ( p = 0.078), EPV ( p = 0.155) and IRFPV ( p = 0.324) did not change after HD. In patients with body weight reduction ≥2.5 kg, E ( p p = 0.001) and EPV ( p = 0.001) decreased significantly but IRFPV ( p = 0.715) was still constant after HD. In conclusion, IRFPV may be a load-independent parameter in assessing left ventricular diastolic function. However, Ea and EPV are load-independent only at minor load alterations. In evaluating left ventricular diastolic function in HD patients whose loading conditions frequently vary with time, IRFPV seems to be more adequate than Ea and EPV. (E-mail: wcvoon@giga.net.tw )

To evaluate whether isovolumic relaxation flow propagation velocity (IRFPV) is independent of preload alterations, 41 healthy subjects (35 +/- 7 years) were included for Doppler examinations at three different positions, i.e., supine, Trendelenburg, and reverse Trendelenburg. A positional difference was detected in the peak velocity of the transmitral early diastolic flow wave (P = 0.012) and the peak velocities of both early (P = 0.004) and late (P = 0.007) diastolic mitral annular velocity waves. In contrast, there was no positional difference in the early diastolic inflow propagation velocity or IRFPV. In conclusion, IRFPV is a preload-independent Doppler parameter.

To evaluate the propagation velocity of isovolumic relaxation flow within the left ventricle (IRFPV) associated with impaired ventricular relaxation, 49 patients with diseases known to impair ventricular relaxation (disease group) and 38 age-matched control subjects (control group) were studied. IRFPV was measured as the slope of the first aliasing velocity line segment of the isovolumic relaxation flow wave front in the color M-mode Doppler echocardiogram. Compared with the control group, the disease group had thicker interventricular septum and left ventricular posterior wall, more left ventricular mass, and lower early diastolic mitral annular velocity (8 +/- 3 vs 11 +/- 4 cm/s, P.001), early (E) wave propagation velocity (47 +/- 16 vs 70 +/- 41 cm/s, P = .002), and IRFPV (193 +/- 149 vs 395 +/- 220 cm/s, P.001). No matter in subgroup or whole population analysis, either the early diastolic mitral annular velocity or the E wave propagation velocity was selected as one of the determinants of IRFPV. In conclusion, diseases impairing ventricular relaxation may retard IRFPV.

Objectives The aim of this study was to investigate the changes of flow propagation velocity (FPV) after regular hemodialysis (H/D) in patient who were uremic with different baseline left ventricular (LV) functions. Methods In all, 24 patients with uremia and abnormal LV systolic function were enrolled in this study and 30 patients with uremia and normal LV systolic performance served as the control group. All patients had in sinus rhythm and underwent a comprehensive transthoracic echocardiographic examination and mitral FPV by color M-mode echocardiography before and after H/D. Results The decline in FPV before H/D was proportional to the decline in the baseline LV function, whereas FPV after H/D varied according to the LV ejection fraction. An obvious decrement of FPV for patients with normal LV systolic function was noted, but no obvious difference was seen for patients with abnormal LV systolic function. Conclusion FPV was strongly preload dependent for patients with normal LV systolic function. It was not significantly influenced by preload for patients with abnormal LV systolic function. FPV is a relatively good diastolic parameter for investigating patients with LV systolic dysfunction.

Several studies have demonstrated that the ratio of peak E wave velocity/flow propagation velocity (E/FPV) using color M-mode Doppler echocardiography and the mitral E wave deceleration time make it possible to estimate left ventricular filling pressure. Recent studies have indicated that deceleration time can predict left ventricular dilation after acute myocardial infarction. The purpose of this study was to determine whether the early assessment of deceleration time and E/FPV could predict left ventricular dilation after acute myocardial infarction. We studied 55 patients with first anterior acute myocardial infarction who underwent successful coronary angioplasty by two-dimensional (2-D) Doppler echocardiography within 12 hours and at 1 and 6 months after reperfusion. Patients were divided into three groups according to deceleration time and E/FPV immediately after reperfusion: (1). restrictive filling (deceleration time or= 2.0), (2). elevated filling pressure (deceleration time >or= 140 msec and E/FPV >or= 2.0), (3). and normal filling pressure (deceleration time >or= 140 msec and E/FPV < 2.0). The end-diastolic volume index (EDVI) was similar in the three groups immediately after reperfusion. EDVI in the groups with restrictive filling and elevated filling pressure was significantly greater than that in the group with normal filling pressure at 6 months (93 +/- 11 and 89 +/- 16 vs 59 +/- 11 ml/m(2), respectively; P < 0.0001). E/FPV shows a better correlation with the change in EDVI at 6 months than deceleration time (r = 0.77; P < 0.0001 and r = - 0.46; P < 0.001, respectively). The early measurement of E/FPV provides a simple and accurate means for predicting left ventricular dilation after acute myocardial infarction.

A magnetic resonance imaging projective velocity encoding sequence was used to determine the pulse-wave velocity in an artery model. To this end, a well-defined flow phantom simulating flow propagation in large arteries was used. In order to validate the measurement method in the presence of large reflected waves, these were deliberately created in the phantom. The projective sequence was applied to two measurement sites and the wave velocity was determined from the spatial and temporal separations of the foot of the velocity waveform. A theoretical model describing reflection and attenuation phenomena was compared with experimental velocity waveforms. The model showed that reflections and attenuation can explain the important changes in velocity waveforms. The model also confirmed that in the presence of reflecting waves, the foot of the waveform can be used as a characteristic point for measurements through changes in the waveform. J. Magn. Reson. Imaging 2001;14:120–127. © 2001 Wiley-Liss, Inc.

The purpose of this study was to assess the effects of preload alterations on color M-mode flow propagation velocity (Vp) in volunteers with normal left ventricular (LV) function and in patients with depressed LV function. Color M-mode Doppler echocardiography was performed during Valsalva maneuver, passive leg lifting, and after administration of nitroglycerin in 30 healthy volunteers and in 30 age- and sex-matched patients with previous myocardial infarction (MI). Mean Vp in controls was 74 +/- 15 cm/s at baseline and 46 +/- 15 cm/s in MI patients (P.0005). In both groups, minor changes in Vp were seen during preload alterations; however, these were not significant (control P =.72, MI P =.31). In both groups, peak E-wave velocity (P.0005), ratio of early-to-late peak velocities (P.0005), and E-wave deceleration time (P.0005) were found to change during preload alterations. In conclusion, we found that in controls and patients with previous MI, the color M-mode flow propagation velocity is not affected significantly by preload.

The aim of the present study was to investigate whether slowing of mitral-to-apical filling is present in patients with acute myocardial infarction (AMI). Twenty-eight patients with their first AMI were examined by color M-mode Doppler echocardiography. Twenty-eight age- and sex-matched healthy individuals served as control subjects. From the color M-mode Doppler images, we measured the time difference (TD) between occurrence of peak flow velocity at the mitral tip and in the apical region by a blinded analysis. The TD was increased in the AMI group compared with the control subjects (70 ± 60 versus 40 ± 30 msec, p = 0.02) and correlated with peak SGOT (r = 0.46, p = 0.02) and age (r = 0.57, p In the 15 patients with anterior AMI, the correlation between TD and SGOT was better (r = 0.68, p . This study demonstrated slowing of early diastolic mitral-to-apical flow propagation in patients with AMI. Infarction size and age appear to be of importance for the retardation of mitral-to-apical flow propagation. (J Am Soc Echocardiogr 1998;11:119-25.)

Aim: To evaluate the incremental value of sophisticated evaluation of leftventricular filling pressure for determining systolo-diastolic interactions. Methods: 51 patients underwent echography to evaluate systolic (ejection fraction (EF)), and diastolic functions (mitral Doppler for E/A, deceleration time(DT), E wave flow propagation velocity (Vp), early diastolic velocity of lateral mitral annulus (Ea)) and BNP. Results: Significant increases of BNP between the 3 tertiles for E/Vp(p