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Left ventricular filling pressure: pathogenesis and ultrasonic assessment

Ageev F. T., Ovchinnikov A. G.
Federal State Budgetary Institution, “Russian Cardiology Research and Production Complex” of the RF Ministry of Health Care, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: left ventricle filling pressure, diastolic dysfunction of the left ventricle, echocardiography

DOI: 10.18087/rhfj.2012.5.1748

The article describes the different aspects of LV filling pressure, a key indicator of central hemodynamics. It conceders the basic mechanisms of high filling pressure development and provides of a filling pressure assessment algorithm depending on LV contractility, and in patients with different diseases.
  1. Агеев Ф. Т. Отчет по НИР «Распространенность и особенности патогенеза ДД ЛЖ и диастолической СН, а также пути оптимизации диагностики и лечения больных с ДД ЛЖ и диастолической СН в условиях амбулаторной практики» (№ Гос. регистрации: 0120506079), 75 стр., Москва 2010 г.
  2. Redfield MM, Jacobsen SJ, Burnett JC Jr et al. Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA. 2003;289 (2):194–202.
  3. Bhatia RS, Tu JV, Lee DS et al. Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study. N Engl J Med. 2006;355 (3):260–269.
  4. Hillis GS, Moller JE, Pellikka PA et al. Noninvasive estimation of left ventricular filling pressure by E / e' is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol. 2004;43 (3):360–367.
  5. Unverferth D, Magorien R, Moeschberger M et al. Factors influen­cing the one-year mortality of dilated cardiomyopathy. Am J Cardiol. 1984;54 (1):147–152.
  6. Nagueh SF, Appleton CP, Gillebert TC et al. Recommendations for the evaluation of left ventricular diastolic function by echocardio­graphy. J Am Soc Echocardiogr. 2009;22 (2):107–133.
  7. Rahimtoola S, Loeb H, Ehsani A et al. Relationship of pulmonary artery to left ventricular diastolic pressures in acute myocardial infarction. Circulation. 1972;46 (2):283–290.
  8. Овчинников А. Г. Роль нарушения баланса коллагена в формировании диастолической дисфункции и оптимизация лечения больных с диастолической дисфункцией с учетом ее тяжести и выраженности клинических проявлений. Автореферат диссертации на соискание ученой степени д.м.н. Москва, 2012 г. (в печати).
  9. Азизова А., Овчинников А., Агеев Ф. Сравнительное влияние торасемида и фуросемида на клинический статус и диастолическую функцию левого желудочка у больных с компенсированной сердечной недостаточностью и высоким давлением наполнения левого желудочка. Журнал Сердечная Недостаточность 2011;12 (6):326–332.
  10. Meta-analysis Research Group in Echocardiography (MeRGE) Heart Failure Collaborators. Independence of restrictive filling pattern and LV ejection fraction with mortality in heart failure: an individual patient meta-analysis. Eur J Heart Fail. 2008;10 (8):786–792.
  11. Zile MR, Bennett TD, St John Sutton M et al. Transition from chronic compensated to acute decompensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures. Circulation. 2008;118 (14):1433–1441.
  12. Gheorghiade M, Filippatos G, De Luca L, Burnett J. Congestion in acute heart failure syndromes: an essential target of evaluation and treatment. Am J Med. 2006;119 (12 Suppl 1):S3‑S10.
  13. Mahdyoon H, Klein R, Eyler W et al. Radiographic pulmonary congestion in end-stage congestive heart failure. Am J Cardiol. 1989;63 (9):625–627.
  14. Stevenson LW, Perloff JK. The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. JAMA. 1989;261 (6):884–888.
  15. Adamson PB, Magalski A, Braunschweig F et al. Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system. J Am Coll Cardiol. 2003;41 (4):565–571.
  16. Yu CM, Wang L, Chau E et al. Intrathoracic impedance monito­ring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization. Circulation. 2005;112 (6):841–848.
  17. Cotter G, Metra M, Milo-Cotter O et al. Fluid overload in acute heart failure--re-distribution and other mechanisms beyond fluid accumulation. Eur J Heart Fail. 2008;10 (2):165–169.
  18. Chaudhry SI, Wang Y, Concato J et al. Patterns of weight change preceding hospitalization for heart failure. Circulation. 2007;116 (14):1549–1554
  19. Milo-Cotter O, Adams KF, O'Connor CM et al. Acute heart failure associated with high admission blood pressure--a distinct vascular disorder? Eur J Heart Fail. 2007;9 (2):178–183.
  20. Higginbotham MB, Morris KG, Williams RS et al. Regulation of stroke volume during submaximal and maximal upright exercise in normal man. Circ Res. 1986;58 (2):281–291.
  21. Rodeheffer RJ, Gerstenblith G, Becker LC et al. Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation. 1984;69 (2):203–213.
  22. Poliner LR, Dehmer GJ, Lewis SE et al. Left ventricular performance in normal subjects: a comparison of the responses to exercise in the upright and supine positions. Circulation. 1980;62 (3):528–534.
  23. Nonogi H, Hess OM, Ritter M, Krayenbuehl HP et al. Diastolic properties of the normal left ventricle during supine exercise. Br Heart J. 1988;60 (1):30–38.
  24. Parker JO, Thadani U. Cardiac performance at rest and during exercise in normal subjects. Bull Eur Physiopathol Respir. 1979;15 (5):935–949.
  25. Cheng CP, Igarashi Y, Little WC. Mechanism of augmented rate of left ventricular filling during exercise. Circ Res. 1992;70 (1):9–19.
  26. Borlaug BA, Jaber WA, Ommen SR et al. Diastolic relaxation and compliance reserve during dynamic exercise in heart failure with preserved ejection fraction. Heart. 2011 Jun;97 (12):964–969.
  27. Cheng CP, Noda T, Nozawa T, Little WC. Effect of heart failure on the mechanism of exercise-induced augmentation of mitral valve flow. Circ Res. 1993;72 (4):795–806.
  28. Tan YT, Wenzelburger F, Lee E et al. The pathophysiology of heart failure with normal ejection fraction: exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventri­cular function involving torsion, untwist, and longitudinal motion. J Am Coll Cardiol. 2009;54 (1):36–46.
  29. Tan YT, Wenzelburger F, Lee E et al. Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography. Heart. 2010;96 (12):948–955.
  30. Nagueh S, Sun H, Kopelen H et al. Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. J Am Coll Cardiol. 2001;37 (1):278–285.
  31. McGuire AM, Hagley MT, Hall AF, Kovács SJ. Relationship of the fourth heart sound to atrial systolic transmitral flow deceleration. Am J Physiol. 1997;272 (3 Pt 2):H1527–1536.
  32. Geske JB, Sorajja P, Nishimura RA, Ommen SR. Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation. 2007;116 (23):2702–2708.
  33. Mullens W, Borowski AG, Curtin RJ at al. Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure. Circulation. 2009;119 (1):62–70.
  34. Tschope C, Paulus WJ. Is echocardiographic evaluation of diastolic function useful in determining clinical care? Doppler echocardio­graphy yields dubious estimates of left ventricular diastolic pressures. Circulation. 2009;120 (9):810–820.
  35. Nagueh S, Middleton K, Kopelen H et al. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30 (6):1527–1533.
  36. Yamamoto K, Nishimura R, Chaliki H et al. Determination of left ventricular filling pressure by Doppler echocardiography in patients with coronary artery disease: critical role of left ventricular systolic function. J Am Coll Cardiol. 1997;30 (7):1819–1826.
  37. Nishimura RA, Appleton CP, Redfield MM et al. Noninvasive doppler echocardiographic evaluation of left ventricular filling pressures in patients with cardiomyopathies: a simultaneous Doppler echocardiographic and cardiac catheterization study. J Am Coll Cardiol. 1996;28 (5):1226–1233.
  38. Nagueh S, Kopelen H, Zoghbi W. Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit. Am J Cardiol. 1995;75 (17):1256–1262.
  39. Paulus WJ, Tschope C, Sanderson JE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28 (20):2539–2550.
  40. Little WC, Ohno M, Kitzman DW et al. Determination of left chamber stiffness from the time for deceleration of early left ventricular filling. Circulation. 1995;92 (7):1933–1939.
  41. Giannuzzi P, Imparato A. Temporelli PL et al. Doppler-derived mitral deceleration time of early filling as strong predictor of pulmonary capillary wedge pressure in postinfarction patients with left ventricular systolic dysfunction. J Am Coll Cardiol. 1994;23 (7):1630–1637.
  42. Klein A, Abdalla I, Murray R et al. Age independence of the difference in duration of pulmonary venous atrial reversal flow and transmitral A-wave flow in normal subjects. J Am Soc Echocardiogr. 1998;11 (5):458–465.
  43. Appleton C, Galloway J, Gonzalez M et al. Estimation of left ventricular filling pressures using two-dimensional and Doppler echocardiography in adult patients with cardiac disease: additional value of analyzing left atrial ejection fraction and the difference in duration of pulmonary venous and mitral flow velocity at atrial contraction. J Am Coll Cardiol. 1993;22 (7):1972–1982.
  44. Rivas-Gotz C, Manolios M, Thohan V, Nagueh SF. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol. 2003;91 (6):780–784.
  45. Kuecherer HF, Muhiudeen IA, Kusumoto FM et al. Estimation of mean left atrial pressure from transesophageal pulsed Doppler echocardiography of pulmonary venous flow. Circulation. 1990;82 (4):1127–1139.
  46. Garcia M, Ares M, Asher C et al. An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol. 1997;29 (2):448–454.
  47. Hasegawa H, Little WC, Ohno M et al. Diastolic mitral annular velocity during the development of heart failure. J Am Coll Cardiol. 2003;41 (9):1590–1597.
  48. Diwan A, McCulloch M, Lawrie G et al. Doppler estimation of left ventricular filling pressures in patients with mitral valve disease. Circulation. 2005;111 (24):3281–3289.
  49. Rivas-Gotz C, Khoury D, Manolios M et al. Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation (experimental studies and clinical application). J Am Coll Cardiol. 2003;42 (8):1463–1470.
  50. Tsang TS, Abhayaratna WP, Barnes ME et al. Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter? J Am Coll Cardiol. 2006;47 (5):1018–1023.
  51. Lester S, Rayan E, Schiller N et al. Best method in the clinical practice and in the research studies to determine left atrial size. Am J Cardiol. 1999;84 (7):829–832.
  52. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.
  53. Damy T, Goode KM, Kallvikbacka-Bennett A et al. Determinants and prognostic value of pulmonary arterial pressure in patients with chronic heart failure. Eur Heart J. 2010;31 (18):2280–2290
  54. Lam CS, Roger VL, Rodeheffer RJ et al. Pulmonary hypertension in heart failure with preserved ejection fraction: a community-based study. J Am Coll Cardiol. 2009;53 (13):1119–1126.
  55. Shapiro BP, McGoon MD, Redfield MM. Unexplained pulmonary hypertension in elderly patients.Chest. 2007;131 (1):94–100.
  56. Dokainish H, Zoghbi W, Lakkis N et al. Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation. 2004;109 (20):2432–2439.
  57. Nagueh S, Kopelen H, Quinones M. Assessment of left ventricular filling pressures by Doppler in the presence of atrial fibrillation. Circulation. 1996;94 (9):2138–2145.
  58. Temporelli PL, Scapellato F, Corra U et al. Estimation of pulmonary wedge pressure by transmitral Doppler in patients with chronic heart failure and atrial fibrillation. Am J Cardiol. 1999;83 (5):724–727.
  59. Chirillo F, Brunazzi C, Barbiero M et al. Estimating mean pulmonary pressure in patients with chronic atrial fibrillation from transthoracic Doppler indexes of mitral and pulmonary venous flow velocity. J Am Coll Cardiol. 1997;30 (1):19–26.
  60. Nagueh S, Mikati I, Kopelen H et al. Doppler estimation of left ventricular filling pressure in sinus tachycardia: a new application of tissue Doppler imaging. Circulation. 1998;98 (16):1644–1650.
  61. Sohn D, Kim Y, Kim H et al. Evaluation of left ventricular diastolic function when mitral E and A waves are completely fused: role of assessing mitral annulus velosity. J Am Soc Echocardiogr. 1999;12 (3):203–208.
  62. Appleton CP, Hatle LK, Popp RL. Demonstration of restrictive ventricular physiology by Doppler echocardiography. J Am Coll Cardiol. 1988;11 (4):757–768.
  63. Klein AL, Hatle LK, Taliercio CP et al. Serial Doppler echocardiographic follow-up of left ventricular diastolic function in cardiac amyloidosis. J Am Coll Cardiol. 1990;16 (5):1135–1141.
  64. Klein AL, Hatle LK, Taliercio CP et al. Prognostic significance of Doppler measures of diastolic function in cardiac amyloidosis: a Doppler echocardiography study. Circulation. 1991;83 (3):808–816.
  65. Nagueh S, Lakkis N, Middleton K et al. Doppler estimation of left ventricular filling pressures in patients with hypertrophic cardiomyo­pathy. Circulation. 1999;99 (2):254–261.
  66. Menzel T, Wagner S, Kramm T et al. Pathophysiology of impaired right and left ventricular function in chronic embolic pulmonary hypertension: changes after pulmonary thromboendarterectomy. Chest. 2000;118 (4):897–903.
  67. Ruan Q, Nagueh SF. Clinical application of tissue Doppler imaging in patients with idiopathic pulmonary hypertension. Chest. 2007 Feb;131 (2):395–401.
  68. Rossi A, Cicoira M, Golia G et al. Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: the advantage of end-diastolic mar­kers. J Am Soc Echocardiogr. 2001;14 (6):562–568.
  69. Olson J, Costa S, Young C, Palac R. Early mitral filling / diastolic mitral annular velocity ratio is not a reliable predictor of left ventricular filling pressure in the setting of severe mitral regurgitation. J Am Soc Echocardiogr. 2006;19 (1):83–87.
  70. Bruch C, Stypmann J, Gradaus R et al. Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. Am J Cardiol. 2004;93 (3):324–328.
  71. Hatle LK, Appleton CP, Popp RL. Differentiation of constrictive pericarditis and restrictive cardiomyopathy by Doppler echocardiography. Circulation. 1989;79 (2):357–370.
  72. Oh JK, Hatle LK, Seward JB et al. Diagnostic role of Doppler echocardiography in constrictive pericarditis. J Am Coll Cardiol. 1994 Jan;23 (1):154–62.
  73. Tabata T, Kabbani SS, Murray RD et al. Difference in the respiratory variation between pulmonary venous and mitral inflow Doppler velocities in patients with constrictive pericarditis with and without atrial fibrillation. J Am Coll Cardiol. 2001;37 (7):1936–1942.
  74. Garcia MJ, Rodriguez L, Ares M et al. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol. 1996;27 (1):108–114.
  75. Ha JW, Ommen SR, Tajik AJ et al. Differentiation of constrictive pericarditis from restrictive cardiomyopathy using mitral annular velocity by tissue Doppler echocardiography. Am J Cardiol. 2004;94 (3):316–319.
  76. Choi EY, Ha JW, Kim JM et al. Incremental value of combining systolic mitral annular velocity and time difference between mitral inflow and diastolic mitral annular velocity to early diastolic annular velocity for differentiating constrictive pericarditis from restrictive cardiomyopathy. J Am Soc Echocardiogr. 2007;20 (6):738–743.
  77. Ha JW, Lulic F, Bailey KR et al. Effects of treadmill exercise on mitral inflow and annular velocities in healthy adults. Am J Cardiol. 2003;91 (1):114–115.
  78. Ha J, Oh J, Pellikka P et al. Diastolic stress echocardiography: a no­vel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr. 2005;18 (1):63–68.
  79. Burgess MI, Jenkins C, Sharman JE, Marwick TH. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol. 2006;47 (9):1891–1900.
  80. Duncan AM, Lim E, Gibson DG, Henein MY. Effect of dobutamine stress on left ventricular filling in ischemic dilated cardiomyopathy: pathophysiology and prognostic implications. J Am Coll Cardiol. 2005;46 (3):488–496.
  81. Stoylen A, Slordahl S, Skjelvan G et al. Strain rate imaging in normal and reduced diastolic function: comparison with pulsed Doppler tissue imaging of the mitral annulus. JJ Am Soc Echocardiogr. 2001;14 (4):264–274.
  82. Kukulski T, Jamal F, D?Hooge J et al. Acute changes in systolic and diastolic events during clinical angioplasty: a comparison of regional velocity, strain rate, and strain measurement. J Am Soc Echocardiogr. 2002;15 (1):1–12.
  83. Tekemoto Y, Pellikka P, Wang J et al. Analysis of the interaction between segmental relaxation patterns and global diastolic function by strain echocardiography. J Am Soc Echocardiogr. 2005;18 (9):901–906.
  84. Kato TS, Noda A, Izawa H et al. Discrimination of nonobstructive hypertrophic cardiomyopathy from hypertensive left ventricular hypertrophy on the basis of strain rate imaging by tissue Doppler ultrasonography. Circulation. 2004;110 (25):3808–3814.
Ageev F. T., Ovchinnikov A. G. Left ventricular filling pressure: pathogenesis and ultrasonic assessment. Russian Heart Failure Journal. 2012;13(5):287-309

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