The relation of the peak Doppler E-wave to peak mitral annulus velocity ratio to diastolic function

Jennifer Lisauskas, Jasvindar Singh, Michael Courtois, Sándor J. Kovács

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48 Scopus citations


Previous observations (Garcia et al. 1998; Sohn et al. 1997; Nagueh et al. 1997) indicate that mitral annulus velocity may be viewed as a 'load-independent' index of filling and that wedge pressure is linearly related to the transmitral flow velocity (VE) to mitral annulus velocity (VMA) ratio (VE/VMA) measured at maximum velocity. In healthy subjects, the mean value observed for [VE]max/[VMA]max was 1:0.23 ≅ 4. No prior physiologic or physical explanation for the basis of, or for the magnitude of, the ratio has been proposed. We propose a physiologic, model-based, quantitative explanation for these observations and test our simplified model's prediction in an invasive (n = 30) and noninvasive (n = 34) test groups of subjects. The simplified geometric model is based on the known constant volume (within a few percentage points) attribute of the four-chambered heart. Accordingly, left-atrial and left-ventricular volumes reciprocate so that their sum is constant throughout the cardiac cycle. The model predicts that: 1. the ratio (VE/VMA) is a constant ≅3 in healthy hearts; and 2. VE/VMA should be linearly proportional to left ventricular end-diastolic pressure (LVEDP). Model prediction was tested using VE and VMA echocardiographic data from 34 subjects (noninvasive group), and simultaneous echocardiographic and high-fidelity hemodynamic (LVEDP) data in 30 subjects (invasive group). Excellent agreement was observed between model prediction and observed data. For the noninvasive (healthy) group, [VE]max/[VMA]max = 4.20 ± 1.11. For the invasive group, [VE]max/[VMA]max was observed to be linearly related to LVEDP, [VE]max/[VMA]max = 0.19 (LVEDP) + 1.54, r = 0.92. Hence, [VE]max/[VMA]max is a legitimate flow-derived index of diastolic function because it is a derivable consequence of the heart's constant-volume pump attribute. (E-mail:

Original languageEnglish
Pages (from-to)499-507
Number of pages9
JournalUltrasound in Medicine and Biology
Issue number4
StatePublished - Apr 2001


  • Diastole
  • Echocardiography
  • Law of the heart
  • Physiologic modeling

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