title: Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation.
abstract: OBJECTIVE
  To determine the effect of preload in color M-mode Doppler flow propagation velocity (v(p)).
  
  
  BACKGROUND
  The interpretation of Doppler filling patterns is limited by confounding effects of left ventricular (LV) relaxation and preload. Color M-mode v(p) has been proposed as a new index of LV relaxation.
  
  
  METHODS
  We studied four dogs before and during inferior caval (IVC) occlusion at five different inotropic stages and 14 patients before and during partial cardiopulmonary bypass. Left ventricular (LV) end-diastolic volumes (LV-EDV), the time constant of isovolumic relaxation (tau), left atrial (LA) pre-A and LV end-diastolic pressures (LV-EDP) were measured. Peak velocity during early filling (E) and v(p) were extracted by digital analysis of color M-mode Doppler images.
  
  
  RESULTS
  In both animals and humans, LV-EDV and LV-EDP decreased significantly from baseline to IVC occlusion (both p < 0.001). Peak early filling (E) velocity decreased in animals from 56 +/- 21 to 42 +/- 17 cm/s (p < 0.001) without change in v(p) (from 35 +/- 15 to 35 +/- 16, p = 0.99). Results were similar in humans (from 69 +/- 15 to 53 +/- 22 cm/s, p < 0.001, and 37 +/- 12 to 34 +/- 16, p = 0.30). In both species, there was a strong correlation between LV relaxation (tau) and v(p) (r = 0.78, p < 0.001, r = 0.86, p < 0.001).
  
  
  CONCLUSIONS
  Our results indicate that color M-mode Doppler v(p) is not affected by preload alterations and confirms that LV relaxation is its main physiologic determinant in both animals during varying lusitropic conditions and in humans with heart disease.
authors.affiliation: Cardiovascular Imaging Center, Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA. garciam@ccf.org
authors.forename: M J
authors.initials: MJ
authors.lastname: Garcia
authors.forename: N G
authors.initials: NG
authors.lastname: Smedira
authors.forename: N L
authors.initials: NL
authors.lastname: Greenberg
authors.forename: M
authors.initials: M
authors.lastname: Main
authors.forename: M S
authors.initials: MS
authors.lastname: Firstenberg
authors.forename: J
authors.initials: J
authors.lastname: Odabashian
authors.forename: J D
authors.initials: JD
authors.lastname: Thomas
mesh_terms: D000368:Aged; D000818:Animals; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D003971:Diastole / Q000502:physiology; D004285:Dogs; D018618:Echocardiography, Doppler, Color; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D012016:Reference Values; D016277:Ventricular Function, Left / Q000502:physiology*