Influence of left ventricular relaxation on the pressure half time of aortic regurgitation
S F de Marchi, S Windecker, B C Aeschbacher, C Seiler
Cardiology,
University Hospital, Inselspital, Freiburgstrasse, 3010 Bern,
Switzerland
Correspondence to: Dr Seiler. email: christian.seiler{at}insel.ch
Accepted for publication 7 June 1999
BACKGROUND
The
severity of aortic regurgitation can be estimated using pressure half
time (PHT) of the aortic regurgitation flow velocity, but the
correlation between regurgitant fraction and PHT is weak.
AIMTo test the
hypothesis that the association between PHT and regurgitant fraction is
substantially influenced by left ventricular relaxation.
METHODSIn 63 patients
with aortic regurgitation, subdivided into a group without (n = 22)
and a group with (n = 41) left ventricular hypertrophy, regurgitant
fraction was calculated using the difference between right and left
ventricular cardiac outputs. Left ventricular relaxation was assessed
using the early to late diastolic Doppler tissue velocity ratio of the
mitral annulus (E/ADTI), the E/A ratio of mitral inflow (E/AM), and the
E deceleration time (E-DT). Left ventricular hypertrophy was assessed
using the M mode derived left ventricular mass index.
RESULTSThe overall
correlation between regurgitant fraction and PHT was weak
(r = 0.36, p < 0.005). In patients
without left ventricular hypertrophy, there was a significant
correlation between regurgitant fraction and PHT
(r = 0.62, p < 0.005), but not in
patients with left ventricular hypertrophy. In patients with a left
ventricular relaxation abnormality (defined as E/ADTI< 1, E/AM< age
corrected lower limit, E-DT 
220 ms), no associations between
regurgitant fraction and PHT were found, whereas in patients without
left ventricular relaxation abnormalities, the regurgitant fraction to
PHT relations were significant (normal E/AM:
r = 0.57, p = 0.02; E-DT< 220 ms:
r = 0.50, p < 0.001; E/ADTI < 1:
r = 0.57, p = 0.02).
CONCLUSIONSOnly
normal left ventricular relaxation allows a significant decay of PHT
with increasing aortic regurgitation severity. In abnormal relaxation,
which is usually present in left ventricular hypertrophy, wide
variation in prolonged backward left ventricular filling may cause
dissociation between the regurgitant fraction and PHT. Thus the PHT
method should only be used in the absence of left ventricular
relaxation abnormalities.
Keywords: aortic regurgitation; left ventricular relaxation; pressure half time
© 1999 by Heart
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