Left intraventricular diastolic and systolic pressure gradients

Abstract

To describe left ventricular (LV) function comprehensively, it is crucial to characterize precisely transmitral, intraventricular and transaortic pressure–flow relations. The site of measurement is important; as the measurement location is moved from the mitral valve toward the apex and the outflow tract, important regional pressure differences are recorded inside the LV. These intraventricular pressure gradients (IVPGs) play an important role in ventricular filling in the normal heart and may be abolished by systolic or diastolic dysfunction. Despite their apparent importance in ventricular filling and diastolic function, IVPGs have never been utilized in clinical cardiology, due to the complexity of their acquisition. The application of Doppler echocardiography allows the reconstruction of diastolic IVPGs completely non-invasively, thus avoiding the risk and expense of a cardiac catheterization. Regional pressure gradients are also present during ventricular emptying but their correlation with systolic function is not so clear. The current minireview highlights theories and experimental data on invasive and non-invasive assessment of diastolic and systolic IVPGs and their role in LV filling and emptying. We also review the pathophysiological modulation of regional gradients, their importance in understanding and evaluating the complex phenomena underlying ventricular filling, as well as their potential clinical application.