Late-systolic apical suction and early-diastolic driving force in ischemic heart disease with left ventricular aneurysm: vector flow mapping with invasive validation
T SugiyamaAbstract
Background/Introduction
Vector flow mapping (VFM) can estimate intraventricular pressure differences (IVPDs) noninvasively and thereby quantify hemodynamic forces that contribute to early diastolic filling. Post-infarction left ventricular aneurysm (LVA) is expected to reduce late-systolic apical suction, but VFM-derived indices have not been validated against invasive left atrial–left ventricular (LA–LV) pressure differences.
Purpose
To quantify late-systolic apical suction and early-diastolic driving force by VFM in ischemic heart disease (IHD) with and without LVA, and to evaluate the relationship between VFM-derived IVPDs and invasive LA–LV pressure differences.
Methods
Single-centre observational case–control study. Participants were healthy controls (n=11), IHD without LVA (n=11), and IHD with LVA (n=15). VFM combined with phonocardiography was used to time the second heart sound (S2) and analyse apex-to-base IVPDs frame-by-frame. IVPDs were summarised as recoil IVPD (late systole/isovolumic relaxation) and rapid-filling IVPD (early rapid filling after mitral valve opening); their sum represented an integrated diastolic driving-force index. In IHD groups, the peak early-diastolic LA–LV pressure difference (ICPD_Catheter) was obtained with a pressure-sensor wire; echocardiography and catheterisation were performed on the same day when feasible (within ±4 days) but not simultaneously. The protocol was approved by an institutional ethics committee; participants provided informed consent or opt-out as appropriate.
Results
Compared with IHD without LVA, the LVA group had significantly lower recoil IVPD (1.0±0.7 vs 2.5±1.1 mmHg; P<0.01) and a lower integrated (recoil+rapid-filling) IVPD index (2.7±1.2 vs 4.6±1.9 mmHg; P<0.01), while rapid-filling IVPD was not different (1.7±0.9 vs 2.1±1.7 mmHg; P=0.89). Rapid-filling IVPD correlated with transmitral E-wave velocity (r=0.54; P<0.01). The integrated index correlated with E-wave velocity (r=0.45; P=0.03) and with ICPD_Catheter (r=0.40; P<0.05).
Conclusion(s)
VFM detects marked attenuation of late-systolic apical suction in post-infarction LVA and provides a practical noninvasive index of LA–LV diastolic driving force that correlates with invasive pressure differences. The integrated (recoil+rapid-filling) IVPD index may complement Doppler parameters for physiological assessment of post-infarction remodelling.