Global and Regional Left Ventricular Diastolic Filling at Rest in Patients with Aortic Regurgitation

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Global and regional left ventricular (LV) diastolic filling patterns were analyzed at rest using gated radionuclide techniques in 17 patients with chronic aortic regurgitation (AR) and in 14 control subjects. The timeactivity and its first-derivative curves of the global LV and septal, apical, and lateral regions were computed. The systolic function was similar in both groups in the global LV and in each of the three regions, whereas in patients with AR, diastolic filling was abnormal both globally and regionally and characterized by reduced peak filling rate and delay in peak filling rate, reduced ratio peak filling rate/peak ejection rate, and a longer rapid filling phase. In many patients with AR, there were abrupt increases in filling volume immediately after global end systole in the septal regions, probably reflecting the regurgitant jet of blood from the aorta, so that the percent stroke volume filled at 100 ms after global end systole (%FV) was increased significantly in AR in the septal region (AR 22 ± 7, controls 13 ± 3%; p < 0.001) compared with the controls and 9 (53%) of the 17 patients with AR had increased %FV (>2 SD from the normal mean) in the septal region. There were no significant differences in the %FV in the apical and lateral regions between the two groups. Furthermore, regional peak filling occurred asynchronously in patients with AR. Thus, in patients with AR, there are abnormal patterns of diastolic filling in the global LV and in regions which are characterized by delay and decrease in the filling rate as well as regional asynchrony, and analyzing the regional filling patterns in patients with AR can show localized areas of filling abnormalities during the early diastolic period immediately after global end systole.

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