Key result
High left ventricular filling pressure with moderate to severe mitral regurgitation paradoxically increased early diastolic mitral annular velocity (8.3 cm/s) to levels similar to normal patients.
Why the study?
How does high left ventricular filling pressure with mitral regurgitation affect mitral annular velocity during early diastole measured by tissue Doppler imaging?
Observational (n=243)
How does high left ventricular filling pressure with mitral regurgitation affect mitral annular velocity during early diastole measured by tissue Doppler imaging?
Absolute Event Rate: 8.3% vs 7.7%
In patients with LV dysfunction, moderate to severe mitral regurgitation and high LV filling pressure can paradoxically normalize or increase mitral annular velocity during early diastole, confounding the assessment of diastolic function.
May confound tissue Doppler diastolic assessment in significant mitral regurgitation; leaves open e′ velocity reliability for filling pressure estimation.
AIMS: To evaluate the effect of considerably high left ventricular filling pressure with mitral regurgitation on mitral annular velocity during early diastole. SUBJECTS: Two hundred and forty-three patients who underwent cardiac catheterization for evaluation of chest pain. METHODS: Mitral annular velocity during early diastole was measured by colour M-mode tissue Doppler imaging. Patients were divided into the following three groups according to the cardiac catheterization data. Group A (n=147): patients having left ventricular relaxation time constant tau<46 ms and left ventricular end-systolic volume index <38 ml m(-2); group B (n=88): patients having tau>or=46 ms and/or end-systolic volume index >or=38 ml m(-2); group C (n=8): patients having mean pulmonary capillary wedge pressure >or=16 mmHg in addition to tau>or=46 ms and end-systolic volume index >or=38 ml m(-2). RESULTS: Mitral annular velocity during early diastole was significantly less in group B (4.8+/-1.4 cm s(-1)) than in group A (7.7+/-1.9 cm s(-1)). However, there was no significant difference between groups A and C (8.3+/-0.8 cm s(-1)). A transmitral E/A >1.0 was observed in 12/147 patients of group A, 10/88 of group B, and 8/8 of group C. The incidence of >or=Sellers' grade II mitral regurgitation was higher in group C than the others. CONCLUSIONS: A paradoxically faster mitral annular velocity during early diastole is found in patients having left ventricular dysfunction with moderate to severe mitral regurgitation and considerably high left ventricular filling pressure. Attention should be paid to an interpretation of mitral annular velocity during early diastole regarding left ventricular early diastolic performance in patients having mitral regurgitation with an E/A >1.0 in their transmitral flow.
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Nobuyuki Ohte (2002) conducted an observational in Chest pain evaluated by cardiac catheterization (n=243). High left ventricular filling pressure with mitral regurgitation vs. Normal left ventricular relaxation or left ventricular dysfunction without high filling pressure was evaluated on Mitral annular velocity during early diastole. High left ventricular filling pressure with moderate to severe mitral regurgitation paradoxically increased early diastolic mitral annular velocity (8.3 cm/s) to levels similar to normal patients.
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