Intraventricular Isovolumic Relaxation Flow Patterns Improve the Predicting Power of Doppler Echocardiography for the Left Ventricular Filling Pressure in Patients with Anterior Wall Myocardial Infarction

BACKGROUND AND PURPOSE: Previous studies have shown that left ventricular systolic asynchrony affects both the relaxation and filling phases of diastole. The purpose of this study was to delinate how the anterior wall dyssynergy influenced the intraventricular flow redistribution patterns during the isovolumic relaxation (IVR) period, which delineated the changes in diastolic suction performance and, therefore, determined the significant Doppler flow variables for predicting left ventricular filling pressure. METHODS: Seventy-three patients with anterior wall myocardial infarction and dyssynergy were enrolled. Those who exhibited the whole IVR intraventricular flow redistributing toward the mitral apparatus, which indicated the reverse physiologic intraventricular pressure gradient in early diastole, were classified as group B, otherwise, as group A. The Doppler echocardiographic variables of mitral inflow were correlated with the left ventricular end-diastolic pressures (LVEDP). RESULTS: With lower ejection fraction rate and more apical dyssynergy, the group B patients had much slower mitral flow propagation. For group A patients, the independent determinants for LVEDP were the ratio of mitral flow propagation rate to peak velocity in early diastole, the early mitral flow deceleration time and the IVR time, all occurring in early diastole. In contrast, the only independent determinant for LVEDP in group B patients was the ratio of mitral peak flow velocity in early diastole to that in late diastole. CONCLUSIONS: The intraventricular IVR flow patterns could delineate how the left ventricular systolic dyssynergy influenced the diastolic process, and determine which echocardiographic variables were more useful for predicting LVEDP in patients with anterior wall myocardial infarction.