Quantifying Diastolic Function: From E-Waves as Triangles to Physiologic Contours via the ‘Geometric Method’

Mikhail Golman, William Padovano, Leonid Shmuylovich, Sándor J. Kovács

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Conventional echocardiographic diastolic function (DF) assessment approximates transmitral flow velocity contours (Doppler E-waves) as triangles, with peak (E peak ), acceleration time (AT), and deceleration time (DT) as indexes. These metrics have limited value because they are unable to characterize the underlying physiology. The parametrized diastolic filling (PDF) formalism provides a physiologic, kinematic mechanism based characterization of DF by extracting chamber stiffness (k), relaxation (c), and load (x o ) from E-wave contours. We derive the mathematical relationship between the PDF parameters and E peak , AT, DT and thereby introduce the geometric method (GM) that computes the PDF parameters using E peak , AT, and DT as input. Numerical experiments validated GM by analysis of 208 E-waves from 31 datasets spanning the full range of clinical diastolic function. GM yielded indistinguishable average parameter values per subject vs. the gold-standard PDF method (k: R 2  = 0.94, c: R 2  = 0.95, x o : R 2  = 0.95, p < 0.01 all parameters). Additionally, inter-rater reliability for GM-determined parameters was excellent (k: ICC = 0.956 c: ICC = 0.944, x o : ICC = 0.993). Results indicate that E-wave symmetry (AT/DT) may comprise a new index of DF. By employing indexes (E peak , AT, DT) that are already in standard clinical use the GM capitalizes on the power of the PDF method to quantify DF in terms of physiologic chamber properties.

Original languageEnglish
Pages (from-to)105-119
Number of pages15
JournalCardiovascular Engineering and Technology
Volume9
Issue number1
DOIs
StatePublished - Mar 1 2018

Keywords

  • Diastolic function (DF)
  • E-wave asymmetry
  • Echocardiography
  • Heart failure (HF)
  • Inverse problem of diastole
  • Left ventricle
  • Mathematical modeling
  • Parametrized diastolic filling (PDF) formalism

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