Influence of heart rate, respiration and recipient atrial contraction on pulsed wave transmitral Doppler flow indices in orthotopic heart transplant recipients.

AIMS

The study set out to assess the relative contributions of donor heart rate, respiration and recipient atrial contraction on the mean of pulsed wave transmitral Doppler flow indices in orthotopic heart transplant recipients. This would provide information on the theoretical usefulness of pacemaker synchronization of recipient atrial contraction, as well as on the validity of certain strategies used for pulsed wave Dopper analysis of diastolic left ventricular function, which have excluded beats based on recipient atrial contraction timing.

METHODS

Thirty two consecutive patients undergoing orthotopic heart transplantation in our centre were prospectively studied. The following Doppler indices were analysed: peak early diastolic velocity (E) and its area under the Doppler curve (TVIE), diastolic velocity after donor atrial contraction (A) and its area under the curve (TVIA), the total area under the curve (TVI), the isovolumic relaxation period (IVR), the diastolic filling period, the normalized peak filling rate and the pressure half time.

RESULTS

Only 81 out of 347 recordings (23%) allowed analysis of the recipient P wave and thus recipient atrial contraction timing, heart rate and the respiration phase in 22 patients for a total of 1579 beats. The isovolumic relaxation period, E, pressure half time and TVIA are not influenced by donor heart rate. For the isovolumic relaxation period, E, TVI and TVIE, respiration contributes as much as recipient atrial contraction timing to beat-to-beat variation. Pressure half time, the diastolic filling period and peak filling rate were not affected by respiration. TVI was not affected by recipient atrial contraction timing.

CONCLUSION

With respect to analysis of diastolic function, exclusion of beats based on recipient atrial contraction timing is invalid for the isovolumic relaxation period. E, TVI and TVIE, since these are equally influenced by respiration. Since TVI was not affected by recipient atrial contraction timing, pacemaker synchronization of donor and recipient atria is not expected to be useful in patients with left ventricular diastolic dysfunction.