Determination of parameters of left ventricular diastolic filling with pulsed Doppler echocardiography: Comparison with cineangiography

To determine the relationship between Doppler-derived flow velocity through the mitral anulus and angiographic parameters of left ventricular filling, 30 patients were studied by two-dimensional echocardiography combined with pulsed Doppler echocardiography followed within 1 hr by left ventricular angiography. The average heart rate for each test was 69 beats/min. Doppler-derived parameters included: early peak diastolic velocity (E) and peak atrial velocity, peak filling rate computed as E x cross-sectional area of the mitral anulus derived from the annular diameter, normalized peak filling rate computed as peak filling rate divided by the left ventricular end-diastolic volume determined by two-dimensional echocardiography, and half filling fraction derived from the time-velocity integral of the Doppler-determined velocity curve. Frame-by-frame left ventricular volumes were obtained throughout diastole from single-plane cineangiograms. A volume-time curve with its derivative was generated by computer processing from which peak filling rate, normalized peak filling rate, and half filling fraction were measured. Morphologically, the Doppler-derived velocity profile resembled the derivative of the angiographic volume curve. In patients with reduced angiographic peak filling rates, early peak diastolic velocity was often decreased less than 45 cm/sec with a relative increase in peak atrial velocity resulting in an early peak diastolic velocity to peak atrial velocity ratio less than 1.0. There were no significant differences in mean values for peak filling rate, normalized peak filling rate, and half filling fraction by Doppler echocardiography vs angiographic (296 vs 283 ml/sec, 1.9 vs 2.0 sec^-1 and 0.55 vs 0.55, respectively). A significant correlation was observed between Doppler echocardiographic and angiographic peak filling rate (r = .87, SEE = 91.5 ml/sec) and between Doppler and angiographic normalized peak filling rate (r = .83, SEE = 0.52 sec^-1). The correlation between early peak diastolic velocity and angiographic peak filling rate was significant but with a lower r value (.64). Doppler measurements of half filling fraction or early peak diastolic velocity to peak atrial velocity ratio correlated with angiographic parameters but this was predominantly true for a subgroup of 15 patients with similar diastolic filling periods during both tests (range of r values .71 to .85). These findings validate the use of Doppler measurements of mitral flow velocities in the noninvasive assessment of left ventricular filling dynamics.