Optimization Study Of Left Ventricular Diastolic Function Indexes

Objective:To optimize and screen the diastolic function indexes of left ventricule, measuring mitral valve flow spectrum, pulmonary venous flow pattern, TDI parameters by ultrasound, and left ventricular end-diastolic pressure (LVEDP) by cardiac catheterization and compared their correlation. To explore index which can more accurately evaluate the left ventricular diastolic function.Material and Methods:Chosed55patients (34male and21female) undertaken coronary angiography and left ventricular opcification from August of2012to March of2013in our hospital. The age range of patients was46-81years old, and the average age was64±9. All of selected patients had the sinus rhythm. The cardiac catheter and ultrasonic cardiogram examination were taken in all patients. Left ventricular end-diastolic pressure (LVEDP) was measured using cardiac catheter and the parameters of ultrasonic cardiogram examination included left ventricular ejection fraction (LVEF), mitral valve flow E peak, A peak, DT, Ep/Ap), pulmonary venous flow S wave, D wave, Pva, Pva duration), tissue Doppler imaging parameters included left ventricular lateral wall velocity, Sm wave of ventricular septum, Em wave, Am wave. Simple analysis of linear correlation was calculated between the data obtained through the ultrasound and left ventricular end-diastolic pressure.Results:(1)The ratio which mitral inflow P peak divided by the arithmetic product between early diastolic mitral annulus velocity and systolic velocities of mitral annulus (E/(Em*Sm)) of interventricular septum had the best correlation with left ventricular end diastolic pressure(LVEDP)(r=0.715,<0.01). The correlation of mean value of left ventricular lateral wall velocity was the second (r=0.667,<0.01).The correlation of septum and left ventricular lateral wall was between them.(2) The ratio of the E peak of mitral flow divided by early diastolic mitral annulus velocity (E/Em)) also had better correlation with left ventricular end diastolic pressure (LVEDP). The correlation of E/Em and LVEDP (r=0.623,<0.01) was better than the correlation of left ventricular lateral wall (E/Em’)(r=0.604,<0.01)。(3) The ratio between early diastolic mitral annulus velocity and later diastolic mitral annulus velocity showed the negative correlation with LVEDP. The correlation coefficients of septum and left ventricular lateral wall were (r=-0.597,<0.01) and (r=-0.589,<0.01) respectively.(4) The ratio of mitral flow spectrum E/A showed negative correlation with left ventricular end diastolic pressure (LVEDP), and the correlation was not high (r=-0.473,<0.01).Conclusions:1. The ratio which mitral inflow P peak divided by the arithmetic product between early diastolic mitral annulus velocity and systolic velocities of mitral annulus (E/(Em*Sm)) had better correlation with the LVEDP, And the E/(Em*Sm) of interventricular septum was the first choice, And the method has the advantages of clear image display, access high rate of reproducibility, it can be used as a separate indicator evaluation of left ventricular diastolic function, worthy of clinical application.2. the ratio of the E peak of mitral flow divided by early diastolic mitral annulus velocity (E/Em) had better correlation with the LVEDP,but there is no correlation with left ventricular end diastolic pressure when the E/Em values between8-15,identification of left ventricular diastolic function in this case need to be combined with other methods.3. The ratio of mitral flow spectrum E/A showed negative correlation with left ventricular end diastolic pressure (LVEDP), and the correlation was not high,by the heart rate,age influence, for evaluation of left ventricular diastolic function of limited value.