Key result
Triphasic mitral inflow links to abrupt mid-diastolic volume increases driven by impaired LV relaxation.
Why the study?
The characteristics and hemodynamic mechanisms of triphasic mitral inflow in patients with diastolic dysfunction are not well understood.
Case Report (n=1)
No
This case demonstrates that triphasic mitral inflow in patients with diastolic dysfunction can be hemodynamically explained by an abrupt increase in inflow volume causing a mid-diastolic decrease in LV pressure.
Answers are grounded in this paper and cite their sources.
Refines mitral inflow interpretation in diastolic dysfunction; leaves open its diagnostic or therapeutic role pending validation.
An 85-year-old woman with hypertension was referred to our hospital for the management of chest pain. Echocardiography showed left ventricular (LV) hypertrophy with impaired systolic function (ejection fraction, 40%) and mitral regurgitation. Pulsed Doppler echocardiography for checking mitral inflow showed triphasic mitral inflow velocity. Simultaneous recording of the LV and pulmonary artery wedge (PAW) pressures showed a high mean PAW pressure with a prominent v wave. The LV pressure showed a temporary elevation in early diastole; it was unusually decreased in mid-diastole, and finally was elevated to such an extent that it exceeded PAW pressure. In this patient, the mid-diastolic decrease in LV pressure, despite the presence of simultaneous LV filling flow, cannot be explained by conventional pressure-volume relation; rather it can be attributed to the abrupt increase in the inflow volume due to the impaired diastolic function. This case shows the characteristics of triphasic mitral inflow in patients with diastolic dysfunction.
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Misumi et al. (2011) conducted a case report in Hypertensive heart disease with systolic and diastolic heart failure (n=1). Triphasic mitral inflow was evaluated. Simultaneous cardiac catheterization and echocardiography demonstrated that triphasic mitral inflow can be attributed to an abrupt increase in inflow volume due to impaired diastolic function.
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