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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. OBJECTIVES: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.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Martínez-Legazpi P,Bermejo J,Benito Y,Yotti R,Pérez Del Villar C,González-Mansilla A,Barrio A,Villacorta E,Sánchez PL,Fernández-Avilés F,del Álamo JC

doi

10.1016/j.jacc.2014.06.1205

subject

Has Abstract

pub_date

2014-10-21 00:00:00

pages

1711-21

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(14)05834-3

journal_volume

pub_type

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Contribution of the diastolic vortex ring to left ventricular filling.