Author + information
- Received August 14, 1987
- Revision received November 11, 1987
- Accepted November 30, 1987
- Published online April 1, 1988.
- Christopher P Appleton, MD,
- Liv K Hatle, MD and
- Richard L Popp, MD, FACC∗
- ↵∗Address for reprints: Richard L. Popp, MD, Cardiology Division, CVRC, Stanford University School of Medicine, Stanford, California 94305.
In patients with restriction of cardiac filling of various origins, cardiac catheterization has been traditionally used as part of the diagnostic evaluation to verify the presence of restrictive/constrictive hemodynamics. In an attempt to determine whether this “restrictive” physiology could be demonstrated noninvasively, 14 patients who had a history, physical examination, two-dimensional echocardiogram and catheterization data compatible with a restrictive myocardial process were studied with pulsed wave Doppler ultrasound. Forty normal subjects served as a control group. The Doppler ultrasound evaluation included measurement of peak mitral and tricuspid flow velocities and flow velocity integrals, mitral and tricuspid deceleration times and central venous flow patterns during apnea and inspiration.
The flow velocity recordings across the mitral and tricuspid valves in patients manifesting restriction were markedly different from those in normal subjects, showing shortened deceleration times across both valves, which indicated both an abrupt premature cessation of ventricular filling and the presence of a diastolic dip-plateau contour in ventricular pressure recordings. In addition, abnormal central venous flow velocity reversals with inspiration and diastolic mitral and tricuspid regurgitation were frequently observed, also suggesting the reduced myocardial compliance characteristic of a restrictive myocardial process.
☆ This study was supported in part by National Research Service Award No. 941156365 from the National Institutes of Health, Bethesda, Maryland and grants from the American Heart Association, San Francisco, California.
- Received August 14, 1987.
- Revision received November 11, 1987.
- Accepted November 30, 1987.