Presence and Implication of Temporal Nonuniformity of Early Diastolic Left Ventricular Wall Expansion in Patients With Heart Failure.
BACKGROUND
Early-diastolic left ventricular (LV) longitudinal expansion is delayed with diastolic dysfunction. We hypothesized that, in patients with heart failure (HF), regardless of LV ejection fraction (EF), there is diastolic temporal nonuniformity with a delay of longitudinal relative to circumferential expansion.


RESULTS
Echocardiography was performed in 143 HF patients-50 with preserved EF (HFpEF) and 93 with reduced EF (HFrEF)-as well as 31 normal control subjects. The delay of early-diastolic mitral annular velocity from the mitral Doppler E (TE-e') was measured as a parameter of the longitudinal expansion delay. The delay of the longitudinal early-diastolic global strain rate (SRE) relative to circumferential SRE(DelayC-L) was calculated as a parameter of temporal nonuniformity. Intra-LV pressure difference (IVPD) was estimated with the use of color M-mode Doppler data as a parameter of LV diastolic suction. Although normal control subjects had symmetric LV expansion in early diastole, TE-e'and DelayC-Lwere significantly prolonged in HF regardless of EF (P < .01 vs control for all). Multivariate analysis revealed that DelayC-Lwas the independent determinant of IVPD among the parameters of LV geometry and contraction (β = -0.21; P < .05).


CONCLUSIONS
An abnormal temporal nonuniformity of early-diastolic expansion is present in HF regardless of EF, which was associated with reduced LV suction.
Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi. Electronic address: h-iwano@med.hokudai.ac.jp.
Hiroyuki
H
Iwano
Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
Daisuke
D
Kamimura
Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
Ervin R
ER
Fox
Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
Michael E
ME
Hall
School of Mechanical Engineering, Purdue University, Indiana.
Pavlos
P
Vlachos
Division of Cardiology, University of Mississippi Medical Center, Jackson, Mississippi.
William C
WC
Little
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology
Echocardiography; Heart failure; Left ventricular diastolic function