The Kinematic Filling Efficiency Index of the Left Ventricle: Contrasting Normal vs. Diabetic Physiology

Abstract 

An index of filling efficiency incorporating stiffness and relaxation (S&R) parameters has not been derived or validated, although numerous studies have focused on the effects of altered relaxation or stiffness on early rapid filling and diastolic function. Previous studies show that S&R parameters can be obtained from early rapid filling (Doppler E-wave) via kinematic modeling. E-wave contours are governed by harmonic oscillatory motion modeled via the parameterized diastolic filling (PDF) formalism. The previously validated model determines three (unique) oscillator parameters from each E-wave having established physiological analogues: x_o (load), c (relaxation/viscoelasticity) and k (chamber stiffness). We define the dimensionless, filling-volume–based kinematic filling efficiency index (KFEI) as the ratio of the velocity-time integral (VTI) of the actual clinical E-wave contour fit via PDF to the VTI of the PDF model-predicted ideal E-wave contour having the same x_o and k, but with no resistance to filling (c = 0). To validate the new index, Doppler E-waves from 36 patients with normal ventricular function, 17 diabetic and 19 well-matched non-diabetic controls, were analyzed. E-wave parameters x_o, c and k and KFEI were computed for each patient and compared. In concordance with prior human and animal studies in which c differentiated between normal and diabetic hearts, KFEI differentiated (p < 0.001) between nondiabetics (55.8% ± 3.3%) and diabetics (49.1% ± 3.3%). Thus, the new index introduces and validates the concept of filling efficiency, and, using diabetes as a working example, provides quantitative and mechanistic insight into how S&R affect ventricular filling efficiency. (E-mail: sjk@wuphys.wustl.edu)

Key Words: Diastolic function, Doppler echocardiography, Efficiency, Diabetes, Optimal filling