PHYSIOLOGY OF DIASTOLIC FUNCTION AND TRANSMITRAL PRESSURE-FLOW RELATIONS
Section snippets
TRANSMITRAL PRESSURE-FLOW RELATIONS
As developed in the Appendix, the equation governing blood flow across the mitral valve can be reasonably described by34:
ΔP = (L)dQ/dt + (R)Q2 [Eq. 1]
Where: ΔP is the atrioventricular pressure difference; Q is the volume flow rate (mL/s); and L and R are coefficients related to inertia and resistance. Therefore, (L)dQ/dt represents the pressure difference required to accelerate the flow, and (R)Q2 is the pressure difference that is required to convert pressure energy into kinetic energy. We
MODEL OF LEFT VENTRICULAR CHAMBER PROPERTIES
Having established the relations governing diastolic filling, we now turn to a conceptualization of the ventricular chamber properties that contribute to the driving pressure gradient. To understand the ventricular contribution to the pressure gradient we model the left ventricular chamber as shown in Figure 4. We assume that the myocardium behaves like a structure with an active element (Pa) in parallel with at least three types of passive elements. The active component is due to actin-myosin
THE ROLE OF DIASTOLIC SUCTION
The concept, and hence the role, of diastolic suction has long been controversial, due primarily, in our opinion, to a lack of consensus on a suitable definition. The dictionary's definition of suction is the exertion of a force by means of a reduced pressure. The classical physiologists37, 94 relied on this definition but reached different conclusions. Katz37 maintained that the relaxing ventricle played a significant role in filling, whereas Wiggers94 thought that since filling did not start
THE ROLE OF THE ATRIUM
It is clear from the basic physics and physiology (Equation 1) that the left atrial pressure (LAP) plays a major role in the pressure gradient that drives ventricular filling. The shape of the gradient is influenced by the compliance of the atrium. For example, a stiff atrium, or an atrium that is operating on the stiff portion of its compliance curve, may lead to a larger v wave (i.e., pressure cross-over) and a concomitant increase in the E wave, but when emptying there will be a more rapid
Color M-mode Doppler and Flow Dispersion
Color M-mode Doppler is being employed to study the intracardiac propagation of transmitral flow and its relation to other Doppler indices of ventricular function.24, 78, 87 Further information on local wall motion or elastic recoil is being obtained when this modality is combined with the measurement of intraventricular pressure gradients.17, 61, 78 A corollary to the measurement of intracardiac flow dispersion and pressure gradients is the attempt to develop mathematical analyses of the
ACKNOWLEDGMENTS
My (ELY) ability to write this article derives from my association, and subsequent scientific development, with all my students and fellows, too numerous to mention here. Most, but not all, are cited in the references. All of the shortcomings of this article are, of course, my own. The caste system custom of scientific publication has denied me the opportunity to include the names of my technicians in the references, without whom the experiments from my lab could not have been accomplished:
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Two-Dimensional and Doppler Evaluation of Left Ventricular Filling, Including Pulmonary Venous Flow Velocity
2020, Diastology: Clinical Approach to Heart Failure with Preserved Ejection FractionFluid-structure interaction of an aortic heart valve prosthesis driven by an animated anatomic left ventricle
2013, Journal of Computational PhysicsCitation Excerpt :Available models for simulating blood flow in the heart can be broadly classified based on their spatial dimension and degree of sophistication into four categories [27,28]: (1) lumped and one-dimensional (1D) model; (2) two-dimensional (2D) models; (3) three-dimensional (3D) models with prescribed heart wall motion; and (4) three-dimensional models with coupled FSI simulation of blood flow and tissue mechanics (3D-FSI). 1D models rely on a non-linear relation between the LV pressure and the blood flow via an empirical, black box simulator [29–32,27,33]. Such models are simple to use and can efficiently obtain the pressure and volume curve but they are inherently incapable of providing the flow field inside the LV chamber.
On the three-dimensional vortical structure of early diastolic flow in a patient-specific left ventricle
2012, European Journal of Mechanics, B/FluidsCitation Excerpt :Diastolic dysfunction [1] is an important contributor to heart disease and has been studied extensively in the past.
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2012, JACC: Cardiovascular ImagingCitation Excerpt :Therefore, the causal relationship between LV wall recoil, transmitral flow, and intraventricular pressure gradient demonstrates the importance in defining the performance of the left ventricle during diastole. Quantification of diastolic function and intraventricular pressure gradients using echocardiography is typically based on measuring the changes in the ventricular wall, such as the velocity of wall relaxation (48) and the pulsed wave Doppler pattern of the velocity at the mitral tips. There is a need for studies that relate the well-validated parameters of diastolic function (i.e., τ, pressure–volume loops, the stress–strain ratio) to the morphological data of the resulting flow energetics.
Presto Untwisting and Legato Filling
2009, JACC: Cardiovascular ImagingImpact of Acute Moderate Elevation in Left Ventricular Afterload on Diastolic Transmitral Flow Efficiency: Analysis by Vortex Formation Time
2009, Journal of the American Society of Echocardiography
Address reprint requests to Edward L. Yellin, PhD, Department of Physiology and Biophysics, Albert Einstein College of Medicine, Room M208, 1300 Morris Park Avenue, Bronx, NY 10461, e-mail: [email protected]