Defining left ventricular segmental and global function by echocardiographic intraventricular contrast flow patterns


      Contrast echocardiography improves left ventricular (LV) endocardial border delineation by enhancement of the blood-tissue interface. In particular, the contrast appearing within the LV chamber exhibits characteristic flow patterns over the cardiac cycle, which may be related to the surrounding myocardial wall motion. To determine the relation between the LV intracavitary contrast flow pattern and surrounding wall motion, we reviewed the contrast-enhanced images of 348 consecutive patients studied at rest. We defined 2 different patterns of intracavitary contrast flow as visualized from apical views: a swift, vertical, and homogenous flow towards the apex (pattern A), and a distinctly protracted, swirling, and heterogeneous flow (pattern B). Images recorded on videotapes were reviewed and the type of pattern (A or B) was determined within the initial 30 to 45 seconds of contrast appearance in the left ventricle. Contrast flow patterns interpreted by independent reviewer were then compared with the interpretation of the LV segmental and global function in each patient. Results demonstrate that 224 of 245 (91%) patients exhibiting pattern A had normal LV segmental function. Furthermore, all but 1 patient (102 of 103) with pattern B had ≥1 wall motion abnormality (p <0.0001). Contrast flow pattern B was observed irrespective of the location of LV wall motion abnormality. Global LV function was normal in 93% of patients exhibiting pattern A, whereas varying degrees of LV dysfunction were noted in 83% of patients with pattern B (p <0.0001). The presence of mitral regurgitation (p = 0.46), aortic insufficiency (p = 0.066), or mitral inflow Doppler abnormality (p = 0.102) was not significantly associated with either pattern. Thus, during contrast echocardiography, the LV intracavitary contrast flow pattern complements the assessment of global and segmental LV function.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Jacobs L.E
        • Kotler M.N
        • Parry W.R
        Flow patterns in dilated cardiomyopathy.
        J Am Soc Echocardiogr. 1990; 3: 294-302
        • Pennestri F
        • Biasucci L.M
        • Rinelli G
        • Mongiardo R
        • Lombardo A
        • Rossi E
        • Amico C.M
        • Aquilina O
        • Loperfido F
        Abnormal intraventricular flow patterns in left ventricular dysfunction determined by color Doppler study.
        Am Heart J. 1992; 124: 966-974
        • Delemarre B.J
        • Bot H
        • Visser C.A
        • Dunning A.J
        Pulsed Doppler echocardiographic description of a circular flow pattern in spontaneous left ventricular contrast.
        J Am Soc Echocardiogr. 1988; 1: 114-118
        • Van Dantzig J.M
        • Delemarre B.J
        • Bot H
        • Koster R.W
        • Visser C.A
        Doppler left ventricular flow pattern versus conventional predictors of left ventricular thrombus after acute myocardial infarction.
        J Am Coll Cardiol. 1995; 25: 1341-1346
        • Delemarre B.J
        • Bot H
        • Pearlman A.S
        • Visser C.A
        • Dunning A.J
        Diastolic flow characteristics of severely impaired left ventricles.
        J Clin Ultrasound. 1987; 15: 115-119
        • Schiller N.B
        • Shah P.M
        • Crawford M
        • DeMaria A
        • Devereux R
        • Feigenbaum H
        • Gutgesell H
        • Reichek N
        • Sahn D
        • Schnittger I
        • et al.
        Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on quantitation of two-dimensional echocardiograms.
        J Am Soc Echocardiogr. 1989; 2: 358-367
        • Schiller N.B
        Two-dimensional echocardiographic determination of left ventricular volume, systolic function, and mass. Summary and discussion of the 1989 recommendations of the American Society of Echocardiography.
        Circulation. 1991; 84: 1280-1287
        • Wei K
        • Skyba D.M
        • Firschke C
        • Jayaweera A.R
        • Lindner J.R
        • Kaul S
        Interactions between microbubbles and ultrasound.
        J Am Coll Cardiol. 1997; 29: 1081-1088
        • Beppu S
        • Izumi S
        • Miyatake K
        • Nagata S
        • Park Y.D
        • Sakakibara H
        • Nimura Y
        Abnormal blood pathways in left ventricular cavity in acute myocardial infarction. Experimental observations with special reference to regional wall motion abnormality and hemostasis.
        Circulation. 1988; 78: 157-164
        • Garrahy P.J
        • Kwan O.L
        • Booth D.C
        • DeMaria A.N
        Assessment of abnormal systolic intraventricular flow patterns by Doppler imaging in patients with left ventricular dyssynergy.
        Circulation. 1990; 82: 95-104
        • Maze S.S
        • Kotler M.N
        • Parry W.R
        The contribution of color Doppler flow imaging to the assessment of a left ventricular thrombus.
        Am Heart J. 1988; 115: 479-482
        • Delemarre B.J
        • Visser C.A
        • Bot H
        • Dunning A.J
        Prediction of apical thrombus formation in acute myocardial infarction based on left ventricular spatial flow pattern.
        J Am Coll Cardiol. 1990; 15: 355-360
        • Kessler K.M
        Predictors of left ventricular thrombus formation.
        J Am Coll Cardiol. 1990; 15: 361-362
        • D’Cruz I.A
        • Daly D.P
        • Hand R.C
        Left ventricular shape in idiopathic dilated cardiomyopathy and cardiomyopathy with or without only mild ventricular dilatation.
        Am J Cardiol. 1992; 69: 1499-1501
        • D’Cruz I.A
        • Aboulatta H
        • Killam H
        • Bradley A
        • Hand R.C
        Quantitative two-dimensional echocardiographic assessment of left ventricular shape in ischemic heart disease.
        J Clin Ultrasound. 1989; 17: 569-572