Usefulness of Accelerated Diastolic Reversed Flow Along the Left Ventricular Posterior Wall in Aortic Regurgitation for Estimating Left Ventkdar Function Takashi Koyama, MD, Satoshi Ogawa, MD, Makoto Akaishi, MD, Tsutomu Yoshikawa, MD, Tomomi Meguro, MD, Shunnosuke Handa, MD, and Yoshiro Nakamura, MD patients with AR whose regurgitant jlow was directed toward the LVposterior baseinstead of apex were also excluded beforehand becauseof the lack of diastolic reversedflow along the LVposterior wall. All patients were studied at rest in the left lateral decubitusposition with a Hewlett-Packard echocardiographic instrument (7703OA Ultrasound System). Pulsed-wave Doppler signals were obtained from the apical long-axis view using a 2.5 MHz transducer. Mitraljlow signals weresampled at the level of the tips of the mitral leaflets. Diastolic reversedflow signals were sampled at the centerof the blue color signals representing that flow (Figure I). If there was no visible diastolic reversedjlow signals, we attempted to detect Doppler signals of diastolic reversedjlow betweenthe posterior mitral leaflet and posterobasal wall at the level of the tips of the mitral leaflets, wherediastolic reversedjlow is supposedto be present. Diastolic reversedjlow signals were consideredpresent if well enveloped,biphasic and with a velocity of >0.2 m/s. Statistical significance of a difference of 2 means were determined by Student’s t test. Statistical correlation betweenacceleration of diastolic reversedflow and percentfractional shortening or LV end-systolic dimension were obtained using linear or nonlinear regression analysis. In all patients with severeAR, diastolic reversedjlow signals could be detectedusing the pulsed-waveDoppler method, except for the particular patients described above.In the control group, diastolic reversedflow signals could not be detectedin 2patients. These2 patients were excluded from statistical analysis. From the Cardiopulmonary Division, Department of Medicine and Diastolic reversedflow signals were biphasic and Department of Geriatrics, Keio University School of Medicine, 35 were composedof 2 different signals similar to those Shinanomachi, Shijuku-ku, Tokyo 160, Japan. Manuscript received February 3, 1992; revised manuscript received and accepted May 4, observedin mitral flow signals. Each signal corresponding to E wave (rapidjilling) or A wave (atria1 contrac1992.

imely indication of surgical correction of aortic re T gurgitation (AR) dependson precise evaluation of left ventricular (LV) function. However, it may still be difficult to accurately predict surgical outcomewith only currently available indexes of LV function. We undertook this study to obtain a novel index of LV function from altered LV fluid dynamics in patients with AR. AR flow is expectedto causedefinitive changesin intraventricular flow distributions. The degree of such changes may be mainly determined by the severity of regurgitation but variously affected by chamber size, diastolic property and filling pressureof the left ventricle. Therefore, our hypothesisis that the changesin the intraventricular fluid dynamics reflect LV function in patients with similar degreesof AR. We testedthis hypothesisin patients with severeAR using the Doppler ultrasound technique and obtained a novel index for estimating LV function. Weprospectively studied 30 patients, 21 men and 9 women(mean age 53 years [range 25 to 84) with severe AR undergoing routine echocardiography at Keio University Hospital. Eleven normal subjects (mean age 52 years [range 35 to 691) without any cardiac abnormalities wereselectedas the control group. Only patients with technically good quality studies were included. The severity of AR was evaluated by Doppler color jlow imaging, and only patients with a regurgitantflow transmitting over the papillary muscle level were selected. Patients with atria1fibrillation or coexisting mitral stenosis, or both, were excluded becauseof an abnormal mitral flow pattern irrespective of LV function. Seven

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tion) in mitral flow signals were termed E’ wave or A’ wave (Figure 2). Each wave of diastolic reversedflow signals followed the corresponding wave of mitral flow signals with a slight time delay (30 to 90 ms). The mean peak velocities of each wave, including those of mitral jlow, are listed in Table I. The peak velocity ratio of diastolic reversedand mitral jlows for each corresponding componentwas compared betweenthe patient and control groups (Figure 3). In the patient group, the peak velocity ratio of E’ and E waves (E’/E) was significantly higher than those in the control group, indicating that diastolic reversedflow is accelerated during the rapid filling phase. E’/E was roughly and linearly correlated with both percentfractional shortening and LV end-systolic dimension (r = -0.49 [p