Method Article

Quantification of Global Diastolic Function by Kinematic Modeling-based Analysis of Transmitral Flow via the Parametrized Diastolic Filling Formalism

DOI:

10.3791/51471

September 1st, 2014

In This Article

Summary

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Accurate, causality-based quantification of global diastolic function has been achieved by kinematic modeling-based analysis of transmitral flow via the Parametrized Diastolic Filling (PDF) formalism. PDF generates unique stiffness, relaxation, and load parameters and elucidates 'new' physiology while providing sensitive and specific indexes of dysfunction.

Abstract

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Quantitative cardiac function assessment remains a challenge for physiologists and clinicians. Although historically invasive methods have comprised the only means available, the development of noninvasive imaging modalities (echocardiography, MRI, CT) having high temporal and spatial resolution provide a new window for quantitative diastolic function assessment. Echocardiography is the agreed upon standard for diastolic function assessment, but indexes in current clinical use merely utilize selected features of chamber dimension (M-mode) or blood/tissue motion (Doppler) waveforms without incorporating the physiologic causal determinants of the motion itself. The recognition that all left ventricles (LV) initiate filling by serving as mechanical suction pumps allows global diastolic function to be assessed based on laws of motion that apply to all chambers. What differentiates one heart from another are the parameters of the equation of motion that governs filling. Accordingly, development of the Parametrized Diastolic Filling (PDF) formalism has shown that the entire range of clinically observed early transmitral flow (Doppler E-wave) patterns are extremely well fit by the laws of damped oscillatory motion. This permits analysis of individual E-waves in accordance with a causal mechanism (recoil-initiated suction) that yields three (numerically) unique lumped parameters whose physiologic analogues are chamber stiffness (k), viscoelasticity/relaxation (c), and load (xo). The recording of transmitral flow (Doppler E-waves) is standard practice in clinical cardiology and, therefore, the echocardiographic recording method is only briefly reviewed. Our focus is on determination of the PDF parameters from routinely recorded E-wave data. As the highlighted results indicate, once the PDF parameters have been obtained from a suitable number of load varying E-waves, the investigator is free to use the parameters or construct indexes from the parameters (such as stored energy 1/2kxo2, maximum A-V pressure gradient kxo, load independent index of diastolic function, etc.) and select the aspect of physiology or pathophysiology to be quantified.

Introduction

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Pioneering studies by Katz1 in 1930 revealed that the mammalian left ventricle initiates filling by being a mechanical suction pump, and much effort since then has been devoted to unraveling the workings of diastole. For many years, invasive methods were the only options available for clinical or research assessment of diastolic function (DF)2-16. In the 1970s, however, technical advancements and developments in echocardiography finally gave cardiologists and physiologists practical tools for noninvasive characterization of DF.

Without a unifying causal theory or paradigm for diastole regarding how the heart works when....

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Protocol

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The procedure for acquiring echocardiographic images and analyzing them to obtain the PDF parameters is detailed below. Although cardiac catheterization is mentioned in the subject selection portion below, the methodology described applies only to the echocardiographic portion. The description of the catheterization portion was included for independent validation of model based predictions and is unrelated to the analysis of E-waves via the PDF formalism. Prior to data acquisition, all subjects provide signed, informed consent for participation in the study in accordance with the Institutional Review Board (Human Research Protection Office) at Washington Univ....

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Results

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Doppler waveforms representative of the four different types of filling patterns (normal, pseudonormal, delayed relaxation, constrictive-restrictive) using the method detailed above are shown in Figure 2. Figure 2A shows the normal pattern, which, by itself is indistinguishable from the pseudonormal pattern. Figure 2B shows a delayed relaxation and Figure 2C shows a constrictive-restrictive pattern associated with severe diastolic dysfunction. For clarit.......

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Discussion

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In keeping with our methodologic focus, the key aspects of the methods that facilitate obtaining accurate and meaningful results are highlighted.

ECHOCARDIOGRAPHY

The American Society of Echocardiography (ASE) has guidelines for the performance of transthoracic studies16. During an echo exam, there are a multitude of factors that affect image quality. Factors that are beyond the control of the sonographer include: technical capabilities of the imager bein.......

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Disclosures

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The authors have no competing financial interests.

Acknowledgements

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This work was supported in part by the Alan A. and Edith L. Wolff Charitable Trust, St. Louis, and the Barnes-Jewish Hospital Foundation. L. Shmuylovich and E. Ghosh were partially supported by predoctoral fellowship awards from the Heartland Affiliate of the American Heart Association. S. Zhu received partial support from the Washington University Compton Scholars Program and the College of Arts and Sciences’ Summer Undergraduate Research Award. S. Mossahebi received partial support from the Department of Physics. 

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Philips iE33Philips (Andover, MA)
LabView 6.0National InstrumentsVersion 6.0.2
MATLABMathWorks Version R2010b

References

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  1. Katz, L. N. The role played by the ventricular relaxation process in filling the ventricle. Am. J. Physiol. 95, 542-553 (1930).
  2. Frais, M. A., Bergman, D. W., Kingma, I., Smiseth, O. A., Smith, E. R., Tyberg, J. V. The dependence of the t....

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Tags

Diastolic FunctionParametrized Diastolic FillingTransmitral FlowEchocardiographic AnalysisDoppler E WaveLeft Ventricular FunctionChamber StiffnessCardiac RelaxationNoninvasive Cardiac AssessmentKinematic Modeling

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