Assessment of the temporal relationship between left ventricular relaxation and filling during early diastole using pulsed Doppler echocardiography and tissue Doppler imaging.

The study investigated the temporal relationship between left ventricular (LV) relaxation and filling during early diastole. The transmitral flow (TMF) velocity by pulsed Doppler echocardiography and LV wall motion velocity by pulsed tissue Doppler imaging (TDI) were evaluated in 57 patients with various heart diseases and 33 normal controls. The patients were classified into 2 groups according to the ratio of the peak early diastolic to atrial systolic TMF velocity (E/A): (1) the high A group included 44 patients with an E/A < or = 1, and (2) the pseudonormalization group included 13 patients with an E/A > 1. The isovolumic relaxation time (IRT) from the aortic component of the second heart sound (IIA) to the onset of the E wave of the TMF was measured. The peak early diastolic velocity of the LV posterior wall (Ew) and time from the IIA to the onset of the early diastolic wave (IIA-Ewo) were determined from the LV wall motion velocity assessed by pulsed TDI. The Ew was lower in the pseudonormalization and high A groups than in the control group. The IIA-Ewo was significantly longer in the pseudonormalization and high A groups than in the control group. The time constant of the LV pressure decay at isovolumic diastole (tau) correlated negatively with the Ew, and correlated positively with the IIA-Ewo in all groups. The IIA-Ewo was equal to or shorter than the IRT in control subjects, and was longer than the IRT in patients in the pseudonormalization group. In conclusion, the temporal relationship between LV relaxation and filling during early diastole varied according to the subjects' hemodynamic status. Analysis of TMF by pulsed Doppler echocardiography and LV wall motion velocity by pulsed TDI was useful for detailed evaluation of early diastolic LV hemodynamics.