title: Stratification of impaired relaxation filling patterns by passive leg lifting in patients with preserved left ventricular ejection fraction.
abstract: METHODS
  We evaluated diastolic functional reserve in 108 patients with normal left ventricular ejection fraction (LVEF)> or =50% but abnormal relaxation (ratio of transmitral peak velocity of early and late diastolic flow (E/A)<1) using passive leg lifting. We calculated the pulmonary venous systolic to diastolic flow ratio (S/D) as a marker of left atrial reservoir function, and the time difference between the duration of pulmonary venous retrograde flow (PVAd) and the duration of the mitral A wave (PVAd-Ad) as a marker of left ventricular end-diastolic pressure (LVEDP).
  
  
  RESULTS
  During leg lifting, the E/A was > or =1 in 39 patients (the inverted group); the remaining 69 patients comprised the stable group. Comparing the inverted group with the stable group at baseline, S/D was smaller (1.5+/-0.4 vs. 1.8+/-0.5, P=0.002) and PVAd-Ad greater (11+/-23 ms vs. -23+/-28 ms, P<0.001). Multiple logistic regression analysis revealed that PVAd-Ad and S/D predicted E/A inversion with leg lifting after adjustment for age, LV wall thickness, LV dimension, LVEF, deceleration time of E, and E/E'.
  
  
  CONCLUSIONS
  In patients with preserved LVEF but early diastolic dysfunction, passive leg lifting may identify patients having a less compliant left ventricle and impaired left atrial reservoir function.
authors.affiliation: Cardiovascular Division, Institute of Clinical Medicine, Graduate School of Comprehensive Human Science, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishizu
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Seo
authors.forename: Satoru
authors.initials: S
authors.lastname: Kawano
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Watanabe
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishimitsu
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Aonuma