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J Appl Physiol (October 13, 2005). doi:10.1152/japplphysiol.00617.2005
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Submitted on May 24, 2005
Accepted on October 7, 2005

The Isovolumic Pressure to Early Rapid Filling Decay Rate Relation: Model-based Derivation and Validation Via Simultaneous Catheterization-Echocardiography

Charles S Chung1, David M Ajo2, and Sandor J Kovacs3*

1 Department of Physics, Washington University, St. Louis, MO, USA
2 Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
3 Cardiovascular Biophysics Laboratory, Cardiovascular Division, Washington University School of Medicine, St. Louis, MO, USA; Department of Physics, Washington University, St. Louis, MO, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA

* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.

Transmitral Doppler echocardiography is the preferred method of non-invasive diastolic function assessment. Correlations between catheterization-based measures of isovolumic relaxation (IVR) and transmitral, early rapid filling (Doppler E-wave) derived parameters have been observed, but no model-based, causal explanation has been offered. IVR has also been characterized in terms of its duration as isovolumic relaxation time (IVRT) and by {tau}, the time-constant of IVR by approximating the terminal left ventricular IVR pressure contour as P(t)=P[[infinity]]+Poe-t/{tau}. To characterize the relation between IVR and early rapid filling more fully, simultaneous (micromanometric) left ventricular pressure and transmitral Doppler E-wave data from 25 subjects undergoing elective cardiac catheterization, having normal physiology was analyzed. Tau was determined from the dP/dt vs P (phase) plane and, simultaneous Doppler E-waves provided global indexes of chamber viscosity/relaxation (c), chamber stiffness (k), and load (xo). We hypothesize that temporal continuity of pressure decay at mitral valve opening and physiologic constraints permit the algebraic derivation of linear relations relating 1/{tau} to both peak atrio-ventricular pressure gradient (kxo) and E-wave derived viscosity/relaxation (c), but does not support a similar, causal (linear) relation between DT and {tau} or IVRT. Both predicted linear relations were observed: kxo to 1/{tau} (r=0.71) and c to 1/{tau} (r=0.71). Similarly, as anticipated, only a weak linear correlation between DT and IVRT or {tau} was observed (r=0.41). The observed in-vivo relationship provides insight into the isovolumic mechanism of relaxation and the changing-volume mechanism of early rapid filling via a link of the respective relaxation properties.




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