2 New Measurements Used to Describe the Filling Phase of the Left Ventricle (LV).

The purpose of this study is to introduce novel measurements to improve the classification of ventricular diastolic performance.

There are 2 cohorts. Cohort 1 consists of 100 subjects who were referred and received echo guided biventricular pacemaker optimization. This retrospective component data is being retrieved to compare baseline and final cardiac performance measures. Comparisons will be made between Doppler and 3D echo diastolic and systolic markers. The Doppler diastolic markers will include D-E slope measuring the rate of pressure equalization between the left atrium (LA) and left ventricle (LV) during inspiration and expiration. MV VTI, the velocity time integral of the left ventricular inflow tract (LVIT) a surrogate measure for LV filling volume, averaging three consecutive complexes and minimal and maximal variability. TDI, tissue Doppler Imaging, when coupled with LVIT measures provides an estimation of left ventricular diastolic pressure. IRT, isovolemic relaxation time, an indicator of LA preload, S/D ratio, an indicator of LA compliance/pressure compared to pulmonary venous pressure. LAv, LA volume, a criteria for diastolic dysfunction grading. TRvmax, tricuspid regurgitation maximum velocity, used to estimate right ventricular systolic pressure. 3D measures will be obtained from the volume curve generated from the 3D full volume image acquisition. The 2 slopes being compared are the initial filling (R1) and intermediate filling (R2) rates of volume change over time or R1/R2. LV ejection fraction, diastolic filling time (DFT), ejection time (ET), heart rate (HR), initial filling time (IFT), and stroke volume (SV) are all being measured from the 3D volume curve.

Cohort 2 consists of normal healthy participants to serve as a comparison providing HF diseased state differentiation. All baseline measures performed in cohort 1 will be done for cohort 2.

Primary Objective/Aim/Goal/Hypothesis Hypothesis: To determine if LV volume curves can be used to generate a single number that globally describes diastolic function and identify relationship to current grouping algorithm.

Secondary Objective/Aim/Goal/Hypothesis Hypothesis: To determine if the pulse wave Doppler of the left ventricular inflow tract D-E slope measure and changes correlate with changes in diastolic performance of the LV.

Hypothesis: Does weighting of the volume curve analysis with various features of the curve such as stroke volume, initial filling volume, and initial filling volume percent provide greater sensitivity or specificity in differentiating diastolic performance.

Study Design: This study is a retrospective observational data analysis of echocardiographic images and Doppler waveforms comparing data between measurements and calculations taken at baseline and after final programming of biventricular pacemaker devices performed during a single visit. Additionally, the echo data from 5 normal healthy participants will be acquired during a single visit to establish normal values and demonstrate reproducibility.

Cohort 1

Inclusion criteria

• Underwent pacemaker optimization at study location.
• Pacemaker optimization between May 1, 2007 and August 16, 2015.
• Heart rate less than 95 beats per minute.

Exclusion criteria

• Missing Data Points.
• Poor quality echo images.
• Atrial fibrillation.

Cohort 2 Inclusion Criteria.

• Considered in good cardiac condition.
• Heart rate less than 90 beats per minute.

Exclusion criteria

History of or treatment for:

• Atrial fibrillation.
• Coronary artery disease.
• Heart Attack.
• Pacemaker.
• Cardiomyopathy.
• Diabetes.
• Kidney disease.
• Hypertension. Systolic pressure > 140. Diastolic pressure > 90.
• Lung disease.
• Emphysema.
• Bronchitis.
• Asthma.

Withdrawal Criteria:

• Poor quality echo images.