Koichi Kiyoshige

Genesis of the austin flint murmur: Relation to mitral inflow aortic regurgitant flow dynamics

OBJECTIVES This study was designed to elucidate the genesis of the Austin Flint murmur. BACKGROUND The Austin Flint murmur is an apical diastolic rumble associated with significant aortic regurgitation. The precise mechanism of the murmur remains unclear. METHODS The relation between the Austin Flint murmur and mitral inflow and aortic regurgitant flow dynamics was evaluated nonivasively in 13 patients with moderate to severe aortic regurgitation and 15 control subjects using phonocardiographic and pulsed and color-coded Doppler echocardiographic techniques. The severity of aortic regurgitation was determined by color-coded Doppler echocardiography on the basis of the maximal distance of the regurgitant signal. RESULTS The direction of aortic regurgitant flow was unrelated to the presence of the Austin Flint murmur. The severity of aortic regurgitation was greater in patients with than in those without this murmur. The peak mitral inflow velocity during early diastole (E) was significantly increased, and both peak mitral inflow velocity at atrial contraction (A) and the A/E ratio were significantly decreased in patients with the Austin Flint murmur compared with values in those without this murmur or in control subjects. However, the maximal amplitude of the Austin Flint murmur did not coincide temporally with the peak mitral inflow velocity. The murmur continued both after rapid mitral inflow had ended and during diastolic mitral regurgitation. CONCLUSIONS The increased velocity of early diastolic mitral inflow in patients with the Austin Flint murmur is due to aortic regurgitation, but rapid mitral inflow is not an essential requirement for production of the murmur. In some cases, the Austin Flint murmur may be generated by aortic regurgitant flow alone.

Vector U loop in patients with right ventricular overloading

The U loop of the vectorcardiogram (VCG) was examined qualitatively and quantitatively in 126 normal subjects, 15 subjects with complete right bundle branch block (CRBBB group) and 58 patients with right ventricular overloading (RVO group), using a direct-writing vectorcardiograph with memory function. In normal subjects the U loop was directed similarly to the T loop, i.e., to the left, anteriorly and inferiorly. In the CRBBB group, maximum U vector was smaller, but its direction was not significantly different from that in normal subjects. In the RVO group, the U loop tended to be displaced posteriorly and to the left and was significantly greater in magnitude than that in normal subjects in the horizontal (P less than 0.01) and frontal (P less than 0.001) planes. In the RVO group, a good correlation was found between the direction of maximum U vector and right ventricular systolic pressure. In some cases of the RVO group, the U loop was the only abnormality suggesting right ventricular overloading. These findings suggest that abnormality of the U loop is a good indicator in a diagnosis of right ventricular overloading.

Vector U loop in patients with idiopathic cardiomyopathy

The U loops of vectorcardiograms were recorded in 50 normal subjects, 10 patients with dilated cardiomyopathy (DCM group), and 83 patients with hypertrophic cardiomyopathy (HCM group). The HCM group was divided into three subgroups: those with obstructive hypertrophic cardiomyopathy (HOCM), nonobstructive hypertrophic cardiomyopathy (HNCM), and apical hypertrophy (APH). The spatial characteristics of the U loop were examined qualitatively and quantitatively and were correlated with echocardiographic findings. The magnitude of the U loop was significantly larger in the HCM group, especially in the APH subgroup, than in the normal subjects, but it was not larger in the DCM group. The maximum U vector was significantly displaced anteriorly and to the right in the DCM and HCM groups, especially the APH and HNCM subgroups. In the HNCM and APH subgroups, the magnitude of the U loop correlated significantly with the thickness of the posterior wall of the left ventricle, but not with that of the interventricular septum. These findings suggest that the U loop is related to hypertrophy of the apex and the posterior wall of the left ventricle.

U wave of high-speed and magnified electrocardiogram in left ventricular overloading

In this study we examined by high speed and magnified electrocardiography the quantitative characteristics of the U wave and the clinical significance of a negative U wave in patient with left ventricular over loading. This method permitted more quantitative measurement of the U wave than the ECG at normal magnification (standard ECG)