title: Frequency-based analysis of diastolic function: detrimental phase-shift of the pressure-flow relation characterizes the 'delayed relaxation'; transmitral flow pattern.
abstract: Cardiologists assess the filling (diastolic) function (DF) of the heart by visually determining whether Doppler echocardiographic transmitral E-waves appear to have "normal", "delayed-relaxation" or "constrictive restrictive" patterns. To achieve a causal method of quantitative DF assessment we present a frequency-based approach. In analogy to impedance of electrical circuits, we characterize DF by analysis of the left ventricular (LV) diastolic pressure (P) to transmitral flow (Q) relation during the Doppler E-wave in the frequency domain in terms of Z(omega) = P(omega) / Q(omega), characteristic and input impedance. This allows DF to be expressed in terms of a complex reflection coefficient R* =/R*/e(iphi). Twenty subjects had simultaneous pressure-flow data recorded during catheterization, were dichotomized according to deceleration time (DT) and had E-waves subjected to model-based image processing (MBIP) to determine model parameter c, related to E-wave deceleration. Results show that phase angle phi is linearly related to c ; that both phi and c were significantly different (p < 0.05) between the short (n=12) and long (n=8) DT group. We conclude that the 'delayed relaxation'; pattern is associated with deviation of the phase angle phi from its optimal (pi) value that minimizes reflection and maximizes filling, resulting in modification of the optimal pressure - flow relation in early diastole.
authors.affiliation: Cardiovascular Biophysics Laboratory, Washington University, St. Louis, MO, USA.
authors.forename: Y
authors.initials: Y
authors.lastname: Wu
authors.forename: S J
authors.initials: SJ
authors.lastname: Kovács