A Pilot Study to Analyze the Relationship Between Left Ventricular Systole and Early Diastole: Clues Derived From Longitudinal Mitral Annular Motion

Background: Cardiac rotation of the left ventricle (LV) along its long axis, due to the twisting motion of the double-loop helix orientation, has been shown to explain LV systolic and early diastolic function. However, the assessment of this phenomenon using cardiac magnetic resonance imaging and speckle-tracking echocardiography is not always available and has some limitations. Therefore, we aimed to simplify this assessment using M-mode and tissue Doppler imaging (TDI) interrogation of the mitral annulus (MA). Methods: A total of 75 patients were studied and divided equally into three groups. Group 1 consisted of young patients with normal LV systolic function, Group 2 included older patients also with normal LV systolic function, and Group 3 comprised patients with reduced LV systolic function. Results: As anticipated, MA excursion and TDI systolic velocities showed a strong correlation with LV systolic function. Notably, reduced LV systolic function was also associated with lower calculated MA early diastolic values. Moreover, early diastolic velocities were the only MA M-mode or TDI variable capable of distinguishing patients from all three studied groups. Finally, both MA systolic excursion and measured TDI velocities exhibited a significant correlation with both indices of LV systolic and early diastolic function. Conclusion: Our data suggest that M-mode and TDI interrogation of the MA are not only useful in assessing LV systolic function, but also early LV diastolic function, as these two events are closely linked to longitudinal motion.