E-wave deceleration time may not provide an accurate determination of LV chamber stiffness if LV relaxation/viscoelasticity is unknown

Abstract

Average left ventricular (LV) chamber stiffness (ΔPavg/ΔVavg) is an important diastolic function index. An E-wave-based determination of ΔPavg/ΔVavg (Little WC, Ohno M, Kitzman DW, Thomas JD, Cheng CP. Circulation 92: 1933–1939, 1995) predicted that deceleration time (DT) determines stiffness as follows: ΔPavg/ΔVavg = N(π/DT)2 (where N is constant), which implies that if the DTs of two LVs are indistinguishable, their stiffness is indistinguishable as well. We observed that LVs with indistinguishable DTs may have markedly different ΔPavg/ΔVavg values determined by simultaneous echocardiography-catheterization. To elucidate the mechanism by which LVs with indistinguishable DTs manifest distinguishable chamber stiffness, we use a validated, kinematic E-wave model (Kovács SJ, Barzilai B, Perez JE. Am J Physiol Heart Circ Physiol 252: H178–H187, 1987) with stiffness ( k) and relaxation/viscoelasticity ( c) parameters. Because the predicted linear relation between k and ΔPavg/ΔVavg has been validated, we reexpress the DT-stiffness (ΔPavg/ΔVavg) relation of Little et al. as follows: DT k ≈ [Formula: see text]. Using the kinematic model, we derive the general DT-chamber stiffness/viscoelasticity relation as follows: DT k, c = [Formula: see text](where c and k are determined directly from the E-wave), which reduces to DT k when c ≪ k. Validation involved analysis of 400 E-waves by determination of five-beat averaged k and c from 80 subjects undergoing simultaneous echocardiography-catheterization. Clinical E-wave DTs were compared with model-predicted DT k and DT k, c. Clinical DT was better predicted by stiffness and relaxation/viscoelasticity ( r2 = 0.84, DT vs. DT k, c) jointly rather than by stiffness alone ( r2 = 0.60, DT vs. DT k). Thus LVs can have indistinguishable DTs but significantly different ΔPavg/ΔVavg if chamber relaxation/viscoelasticity differs. We conclude that DT is a function of both chamber stiffness and chamber relaxation viscoelasticity. Quantitative diastolic function assessment warrants consideration of simultaneous stiffness and relaxation/viscoelastic effects.