[Noninvasive estimation of max (dP/dt) of the left ventricle based on maximum aortic flow acceleration as measured by pulsed Doppler echocardiography]

Abstract

To obtain an index of left ventricular contractility, cardiac catheterization is necessary. In the present study, we ascertained whether max(dP/dt) could be obtained noninvasively in vivo based on the theoretical equation, max(dP/dt) not equal to rho cmax(du/dt), where rho is the density of blood, c is the pulse wave velocity of the aorta and max(du/dt) is the maximum acceleration of the aortic blood flow. This equation is based on the theory of pulse wave propagation, and was established in animal experiments. We further attempted to clarify the clinical usefulness of rho cmax(du/dt) by examining the effects of afterload and preload on rho cmax(du/dt). Twenty-seven patients without stenosis of their aortic valves and left ventricular outflow tracts were observed. During cardiac catheterization, we measured max(dP/dt) using a catheter-tip micromanometer, max (du/dt) using pulsed Doppler echocardiography and pulse wave velocity by simultaneously recording the femoral pulse wave and the carotid pulse wave. The measurements were performed at rest, before and after an increase in contractility with dobutamine administration, an increase in afterload with methoxamine administration and an increase in preload by leg elevation. There was good linear correlation (Y = 0.95X + 7.51, r = 0.84, p less than 0.0005) between max(dP/dt)[X] and rho cmax(du/dt)[Y] at rest. When the contractility was changed, rho cmax(du/dt) reflected changing of max(dP/dt). Moreover, when the afterload and preload were increased, the changing pattern of rho cmax(du/dt) was similar to that of max(dP/dt). Max(du/dt), index of cardiac performance previously proposed, showed a different changing pattern than max(dP/dt), indicating that max(du/dt) was influenced substantially by loading conditions. These results indicated that we can obtain max(dP/dt) noninvasively and reliably by measuring rho cmax(du/dt).