Determination of Diastolic Function by Radionuclide Ventriculography IAN P. CLEMENTS, M.D., LAWRENCE J. SINAK, M.D., RAYMOND J. GIBBONS, M.D.  Mayo Clinic Proceedings  Volume 65, Issue 7, Pages 1007-1019 (July 1990) DOI: 10.1016/S0025-6196(12)65164-7 Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Diagram showing relationship of ventricular relaxation and filling to pressure (P) and volume (V) changes as a function of time. Contr = contraction; D = diastole; IC = isovolumic contraction; IR = isovolumic relaxation; RFP = rapid filling phase; S = systole. (From Brutsaert and associates.12 By permission of Grune & Stratton.) Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Smoothed raw data of activity (y-axis) plotted against time in milliseconds (x-axis) to show important points on filling curve. A = onset of filling; B = end of isovolumic period; C = point of peak filling rate; D = end of rapid filling phase; E = end of slow filling phase; F = end of atrial filling phase. (From Sinak and Clements.23 By permission of Reed Publishing USA.) Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Blood-pool time-activity curves obtained sequentially from the same patient by consecutive R-wave gating (A), list-mode acquisition and gated reformatting with an “artificial” cycle length in excess of the actual cycle length entered into the reformatting sequence (B), and alternate R-wave gating (C). Curves were obtained by three-point smoothing of the raw data. E.F. = ejection fraction. (From Clements and associates.27 By permission of C. V. Mosby Company.) Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Blood-pool time-activity curves. A, In normal patient (without cardiac disease). B and C (case 1), In 74-year-old woman with hypertrophic cardiomyopathy before (B) and after (C) initiation of verapamil therapy, 320 mg/day. Despite normal left ventricular ejection fraction (EF), peak filling rate (PFR) was decreased, time to peak filling rate (TPFR) was delayed, and first-half filling fraction (1/2FF) was decreased in comparison with these measurements in a normal patient with a similar cycle length. Treatment with verapamil tended to return the filling abnormalities to normal. EDV = end-diastolic volume. Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 6 Blood-pool time-activity curves. A, In normal patient (without cardiac disease). B and C (case 2), In 73-year-old man with hypertensive cardiomyopathy before (B) and after (C) initiation of verapamil therapy, 360 mg/day. Despite normal left ventricular ejection fraction (EF), peak filling rate (PFR) was decreased, time to peak filling rate (TPFR) was delayed, and first-half filling fraction (1/2FF) was decreased in comparison with these measurements in a normal patient with a similar cycle length. Treatment with verapamil diminished the filling abnormalities. EDV = end-diastolic volume. Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 7 Blood-pool time-activity curves. A, In normal patient (without cardiac disease). B and C (case 3), In 66-year-old woman who had received menogaril (200 mg/m2 per month) for 2 and 6 months, respectively. Left ventricular ejection fraction (EF) remained normal with menogaril treatment; however, peak filling rate (PFR) showed a progressive decline, time to peak filling rate (TPFR) was delayed, and first-half filling fraction (1/2FF) decreased with continued menogaril use. EDV = end-diastolic volume. Mayo Clinic Proceedings 1990 65, 1007-1019DOI: (10.1016/S0025-6196(12)65164-7) Copyright © 1990 Mayo Foundation for Medical Education and Research Terms and Conditions