TY - JOUR
T1 - E-wave generated intraventricular diastolic vortex to L-wave relation
T2 - Model-based prediction with in vivo validation
AU - Ghosh, Erina
AU - Caruthers, Shelton D.
AU - Kovács, Sándor J.
PY - 2014/8/1
Y1 - 2014/8/1
N2 - The Doppler echocardiographic E-wave is generated when the left ventricle's suction pump attribute initiates transmitral flow. In some subjects E-waves are accompanied by L-waves, the occurrence of which has been correlated with diastolic dysfunction. The mechanisms for L-wave generation have not been fully elucidated. We propose that the recirculating diastolic intraventricular vortex ring generates Lwaves and based on this mechanism, we predict the presence of L-waves in the right ventricle (RV). We imaged intraventricular flow using Doppler echocardiography and phase-contrast magnetic resonance imaging (PC-MRI) in 10 healthy volunteers. L-waves were recorded in all subjects, with highest velocities measured typically 2 cm below the annulus. Fifty-five percent of cardiac cycles (189 of 345) had L-waves. Color M-mode images eliminated mid-diastolic transmitral flow as the cause of the observed L-waves. Three-dimensional intraventricular flow patterns were imaged via PC-MRI and independently validated our hypothesis. Additionally as predicted, L-waves were observed in the RV, by both echocardiography and PC-MRI. The re-entry of the E-wave-generated vortex ring flow through a suitably located echo sample volume can be imaged as the L-wave. These waves are a general feature and a direct consequence of LV and RV diastolic fluid mechanics.
AB - The Doppler echocardiographic E-wave is generated when the left ventricle's suction pump attribute initiates transmitral flow. In some subjects E-waves are accompanied by L-waves, the occurrence of which has been correlated with diastolic dysfunction. The mechanisms for L-wave generation have not been fully elucidated. We propose that the recirculating diastolic intraventricular vortex ring generates Lwaves and based on this mechanism, we predict the presence of L-waves in the right ventricle (RV). We imaged intraventricular flow using Doppler echocardiography and phase-contrast magnetic resonance imaging (PC-MRI) in 10 healthy volunteers. L-waves were recorded in all subjects, with highest velocities measured typically 2 cm below the annulus. Fifty-five percent of cardiac cycles (189 of 345) had L-waves. Color M-mode images eliminated mid-diastolic transmitral flow as the cause of the observed L-waves. Three-dimensional intraventricular flow patterns were imaged via PC-MRI and independently validated our hypothesis. Additionally as predicted, L-waves were observed in the RV, by both echocardiography and PC-MRI. The re-entry of the E-wave-generated vortex ring flow through a suitably located echo sample volume can be imaged as the L-wave. These waves are a general feature and a direct consequence of LV and RV diastolic fluid mechanics.
KW - Cardiac magnetic resonance imaging
KW - Diastolic function
KW - Echocardiography
KW - Intraventricular vortex
KW - Ventricular suction
UR - http://www.scopus.com/inward/record.url?scp=84905457464&partnerID=8YFLogxK
U2 - 10.1152/japplphysiol.00215.2014
DO - 10.1152/japplphysiol.00215.2014
M3 - Article
C2 - 24903922
AN - SCOPUS:84905457464
VL - 117
SP - 316
EP - 324
JO - Journal of Applied Physiology
JF - Journal of Applied Physiology
SN - 0161-7567
IS - 3
ER -