title: Contribution of the diastolic vortex ring to left ventricular filling.
abstract: BACKGROUND
  Intraventricular fluid dynamics can be assessed clinically using imaging. The contribution of vortex structures to left ventricular (LV) diastolic function has never been quantified in vivo.
  
  
  OBJECTIVE
  This study sought to understand the impact of intraventricular flow patterns on filling and to assess whether impaired fluid dynamics may be a source of diastolic dysfunction.
  
  
  METHODS
  Two-dimensional flow velocity fields from color Doppler echocardiographic sequences were obtained in 20 patients with nonischemic dilated cardiomyopathy (NIDCM), 20 patients with hypertrophic cardiomyopathy (HCM), and 20 control healthy volunteers. Using a flow decomposition method, we isolated the rotational velocity generated by the vortex ring from the surrounding flow in the left ventricle.
  
  
  RESULTS
  The vortex was responsible for entering 13 ± 6% of filling volume in the control group and 19 ± 8% in the NIDCM group (p = 0.004), but only 5 ± 5% in the HCM group (p < 0.0001 vs. controls). Favorable vortical effects on intraventricular pressure gradients were observed in the control and NIDCM groups but not in HCM patients. Differences in chamber sphericity explained variations in the vortex contribution to filling between groups (p < 0.005).
  
  
  CONCLUSIONS
  The diastolic vortex is responsible for entering a significant fraction of LV filling volume at no energetic or pressure cost. Thus, intraventricular fluid mechanics are an important determinant of global chamber LV operative stiffness. Reduced stiffness in NIDCM is partially related to enhanced vorticity. Conversely, impaired vortex generation is an unreported mechanism of diastolic dysfunction in HCM and probably other causes of concentric remodeling.
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California, San Diego, La Jolla, California.
authors.forename: Pablo
authors.initials: P
authors.lastname: Martínez-Legazpi
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Electronic address: javier.bermejo@salud.madrid.org.
authors.forename: Javier
authors.initials: J
authors.lastname: Bermejo
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Benito
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Yotti
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Candelas
authors.initials: C
authors.lastname: Pérez Del Villar
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: González-Mansilla
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Barrio
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Villacorta
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sánchez
authors.affiliation: Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and the Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Mechanical and Aerospace Engineering Department, University of California, San Diego, La Jolla, California; Institute for Engineering in Medicine, University of California, San Diego, La Jolla, California.
authors.forename: Juan C
authors.initials: JC
authors.lastname: del Álamo
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D002306:Cardiac Volume / Q000502:physiology*; D003971:Diastole / Q000502:physiology; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
keywords: Doppler echocardiography; diastolic function; flow dynamics