Intraventricular flow during isovolumic relaxation: Description and characterization by Doppler echocardiography

Zion Sasson, Liv Hatle, Christopher P. Appleton, Michael Jewett, Edwin L. Alderman, Richard L. Popp

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Abstract

This study describes the characteristics of a prominent Doppler flow velocity signal representing intraventricular flow during left ventricular isovolumic relaxation. The flow during the isovolumic relaxation period was demonstrated in 60 subjects, including 7 with a normal heart, 26 with hypertrophic cardiomyopathy, 10 with aortic valve disease, 9 with a transplanted heart and 8 others. All had normal to hyperdynamic left ventricular systolic function with some degree of cavity obliteration as seen in the apical two-dimensional echocardiographic views. In contrast, this isovolumic relaxation period flow could not be demonstrated in the absence of cavity obliteration in any of 20 patients with either normal or diminished left ventricular systolic function. Isovolumic relaxation period flow was best recorded from the apical transducer position and was directed toward the apex in all patients. By pulsed wave, and with two-dimensional Doppler ultrasound, the isovolumic relaxation period flow originated within a narrow area in the medial portion of the left ventricle along the middle or basal segments of the interventricular septum, but was recorded over a larger area toward the apex. The peak isovolumic relaxation period flow velocity was recorded just basal to the area of cavity obliteration, usually at the level of the papillary muscles, and ranged from 0.4 to 2.3 m/s (mean of 1.0 m/s). This isovolumic relaxation period flow started with aortic valve closure and, in 50 of the 60 patients, it lasted throughout isovolumic relaxation until mitral valve opening. In the other 10 patients (all with hypertrophic cardiomyopathy), it lasted for only a part (mean 63%) of this period. Because of its timing and appearance, this isovolumic relaxation period flow potentially could be confused with the early peak of the diastolic transmitral Doppler flow velocity signal.

Original languageEnglish (US)
Pages (from-to)539-546
Number of pages8
JournalJournal of the American College of Cardiology
Volume10
Issue number3
DOIs
StatePublished - Jan 1 1987

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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