title: Increase in the late diastolic filling force is associated with impaired transmitral flow efficiency in acute moderate elevation of left ventricular afterload.
abstract: OBJECTIVE
  Analysis of intraventricular flow force and efficiency is a novel concept of quantitatively assessing left ventricular (LV) hemodynamic performance. We have parametrically characterized diastolic filling flow by early inflow force, late inflow force, and total inflow force and by vortex formation time (VFT), a fundamental parameter of fluid transport efficiency. The purpose of this study was to determine what changes in inflow forces characterize a decrease in diastolic blood transport efficiency in acute moderate elevation of LV afterload.
  
  
  METHODS
  In 8 open-chested pigs, the flow force and VFT parameters were calculated from conventional and flow Doppler echocardiographic measurements at baseline and during a brief (3-minute) moderate elevation of afterload induced by increasing the systolic blood pressure to 130% of the baseline value.
  
  
  RESULTS
  Systolic LV function decreased significantly during elevated afterload. Early inflow force did not significantly change, whereas late inflow force increased from 5,822.09 +/- 1,656.5 (mean +/- SD) to 13,948.25 +/- 9,773.96 dyne (P = .049), and total inflow force increased from 13,783.35 +/- 4,816.58 to 21,836.67 +/- 8,635.33 dyne (P = .031). Vortex formation time decreased from 4.09 +/- 0.29 to 2.79 +/- 1.1 (P = .0068), confirming suboptimal flow transport efficiency.
  
  
  CONCLUSIONS
  Even a brief moderate increase of LV afterload causes a significant increase in late diastolic filling force and impairs transmitral flow efficiency.
authors.affiliation: Division of Cardiovascular Diseases, Translational Ultrasound Research Laboratory, Mayo Clinic Arizona, Scottsdale, Arizona 85259, USA.
authors.forename: Panupong
authors.initials: P
authors.lastname: Jiamsripong
authors.forename: Anna M
authors.initials: AM
authors.lastname: Calleja
authors.forename: Mohsen S
authors.initials: MS
authors.lastname: Alharthi
authors.forename: Eun Joo
authors.initials: EJ
authors.lastname: Cho
authors.forename: Eileen M
authors.initials: EM
authors.lastname: McMahon
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Heys
authors.forename: Michele
authors.initials: M
authors.lastname: Milano
authors.forename: Partho P
authors.initials: PP
authors.lastname: Sengupta
authors.forename: Bijoy K
authors.initials: BK
authors.lastname: Khandheria
authors.forename: Marek
authors.initials: M
authors.lastname: Belohlavek
mesh_terms: D000208:Acute Disease; D000818:Animals; D001783:Blood Flow Velocity; D001794:Blood Pressure; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D013552:Swine; D014463:Ultrasonography; D014655:Vascular Resistance; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*