Relevance of intraventricular pressure gradients in left ventricular diastolic and systolic function: clinical implications.

Intraventricular pressure gradients (IVPGs) play a physiological role in normal filling and emptying of the left ventricle. Regional alterations in IVPGs might be an important factor in the characteristic changes that occur in intraventricular flow in specific cardiac disorders and may contribute to and represent an early sign of ventricular dysfunction. Diastolic IVPGs, a marker of normal ventricular filling, and systolic IVPGs, a marker of normal ventricular emptying, can be attenuated, lost entirely or even reversed when ventricular emptying is opposed by afterload elevations, after regional acute ischaemia and in failing hearts. Moreover, in patients with severe aortic valve stenosis showing IVPGs impairment, diastoIic and systolic IVPGs improved after aortic valve replacement. The importance of IVPGs in cardiac function has so far not been entirely evaluated. A proof of the prognostic role or of the ability to identify incipient ventricular dysfunction or lack of functional reserve may help clinical decisions, turning non-invasive IVPGs into useful clinical tools.