Background: The response of a normal left ventricle (LV) to an increase in afterload is to increase its rate of relaxation. In diastolic dysfunction LV relaxation is impaired and passive chamber stiffness is increased. We investigated the potential of incremental LV elastance measures, as obtainable by non-invasive means, to assess LV relaxation performance.

Methods and Results: We obtained paired central arterial pressure and LV volume curves from PulseCor and 3D-echo recordings in 62 consecutive subjects aged 71±6 yrs (mean±SD) from an existing community study. Incremental LV elastances at the start (E_se) and end of ejection (E_ee) were calculated as the ratio of dp/dt and dV/dt at corresponding positions in time. In our analysis we considered the inter-relationships of E_ee with heart rate (HR), systolic blood pressure (SBP), pressure relaxation rate (dp/dt_ee), arterial compliance (SV/PP), mitral annulus velocity e′, E/e′, ejection fraction (EF) and the classic non‑invasive ventricular-vascular coupling index (Ees/Ea). Univariate correlations (Table) as well as stratification according to lower and higher E_ee groups showed that a higher E_ee was associated with a higher E_se and with lower arterial compliance and reduced ventricular relaxation rate (e′), despite increased dp/dt_ee. EF and Ees/Ea were not associated with any of these measures.

Conclusions: An increased E_ee reflects slowed ventricular relaxation, which may be due to the impact of reduced arterial compliance on LV diastolic performance. The classic non-invasive ventricular-vascular coupling index Ees/Ea did not reveal such a relationship.