The Evolution of Intraventricular Vortex during Ejection Studied by Using Vector Flow Mapping

Aims: The purpose of this study was to assess the evolution of intraventricular vortex during left ventricular (LV) ejection. Methods: Vector flow mapping was performed in 51 patients with coronary artery disease and LV ejection fraction (EF) >50%, 70 patients with EF <50% (13 with coronary artery disease and 57 with dilated cardiomyopathy), and 62 healthy volunteers. Results: In normals and patients with EF >50%, the intraventricular vortex dissipated quickly during early ejection. In patients with EF <50%, the vortex stayed mainly at apex and persisted for a significantly longer time. The evolution of vortex during ejection was significantly correlated with QRS width, EF, fractional shortening, LV outflow velocity time integral, wall motion score index (WMSI), LV dimensions, left atrial diameter, and diastolic mitral annular velocities. LV end‐diastolic short diameter and WMSI were the independent determinants of the duration of vortex (R² = 0.482, P < 0.001). End‐systolic short diameter and apical WMSI were the independent determinants of duration of vortex corrected for ejection time (R² = 0.565, P < 0.001). End‐systolic short diameter was the independent determinant of percentage change in vortex area during early ejection (R² = 0.355, P < 0.001). End‐systolic short diameter and ejection time were the independent determinants of percentage change in vortex flow volume (R² = 0.415, P < 0.001). Conclusions: In patients with LV systolic dysfunction, the vortex persists during ejection and stays mainly at apex. The vortex evolution during ejection is closely associated with LV dimensions and functions.