Background: Left ventricular untwisting generates an early diastolic intraventricular pressure gradient (DIVPG) than\ncan be quantified by echocardiography. We sought to confirm the quantitative relationship between peak\nuntwisting rate and peak DIVPG in a large adult population.\nMethods: From our echocardiographic database, we retrieved all the echocardiograms with a normal left\nventricular ejection fraction, for whom color Doppler M-Mode interrogation of mitral inflow was available, and left\nventricular untwisting rate was measurable using speckle tracking. Standard indices of left ventricular early diastolic\nfunction were assessed by Doppler (peaks E, eâ?? and Vp) and speckle tracking (peak strain rate Esr). Load\ndependency of DIVPG and untwisting rate was evaluated using a passive leg raising maneuver.\nResults: We included 154 subjects, aged between 18 to 77 years old, 63% were male. Test-retest reliability for color\nDoppler-derived DIVPG measurements was good, the intraclass correlation coefficients were 0.97 [0.91â??0.99] and\n0.97 [0.67â??0.99] for intra- and inter-observer reproducibility, respectively. Peak DIVPG was positively correlated with\npeak untwisting rate (r = 0.73, P < 0.001). On multivariate analysis, peak DIVPG was the only diastolic parameter that\nwas independently associated with untwisting rate. Age and gender were the clinical predictive factors for peak\nuntwisting rate, whereas only age was independently associated with peak DIVPG. Untwisting rate and DIVPG were\nboth load-dependent, without affecting their relationship.\nConclusions: Color Doppler-derived peak DIVPG was quantitatively and independently associated with peak\nuntwisting rate. It thus provides a reliable flow-based index of early left ventricular diastolic function.
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