Key result
DTI mitral annular velocity correlates inversely with tau, identifying pseudonormalization with ~88% sensitivity.
Why the study?
Mitral inflow velocity by Doppler echocardiography is widely used to evaluate left ventricular diastolic function but is affected by other factors, and mitral annulus velocity may provide additional information.
Does mitral annulus velocity measured by Doppler tissue imaging accurately and preload-independently evaluate left ventricular diastolic function?
Observational (n=128)
Does mitral annulus velocity measured by Doppler tissue imaging accurately and preload-independently evaluate left ventricular diastolic function?
Mitral annulus velocity measured by Doppler tissue imaging is a relatively preload-independent parameter that accurately reflects left ventricular diastolic function.
Answers are grounded in this paper and cite their sources.
May support tissue Doppler for preload-independent diastolic assessment; leaves open prospective validation before clinical adoption.
OBJECTIVES This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function. BACKGROUND Mitral inflow velocity recorded by Doppler echocardiography has been widely used to evaluate left ventricular diastolic function but is affected by other factors. The mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function. METHODS Mitral annulus velocity during diastole was measured by Doppler tissue imaging (DTI) 1) in 59 normal volunteers (group 1); 2) in 20 patients with a relaxation abnormality as assessed by Doppler mitral inflow variables (group 2) at baseline and after saline loading; 3) in 11 patients (group 3) with normal diastolic function before and after intravenous nitroglycerin infusion; and 4) in 38 consecutive patients (group 4) undergoing cardiac catheterization in whom mitral inflow velocity and tau as well as mitral annulus velocity were measured simultaneously. RESULTS In group 1, mean +/- SD peak early and late diastolic mitral annulus velocity was 10.0 +/- 1.3 and 9.5 +/- 1.5 cm/s, respectively. In group 2, mitral inflow velocity profile changed toward the pseudonormalization pattern with saline loading (deceleration time 311 +/- 84 ms before to 216 +/- 40 ms after intervention, p < 0.001), whereas peak early diastolic mitral annulus velocity did not change significantly (5.3 +/- 1.2 cm/s to 5.7 +/- 1.4 cm/s, p = NS). In group 3, despite a significant change in mitral inflow velocity profile after nitroglycerin, peak early diastolic mitral annulus velocity did not change significantly (9.5 +/- 2.2 cm/s to 9.2 +/- 1.7 cm/s, p = NS). In group 4, peak early diastolic mitral annulus velocity (r = -0.56, p < 0.01) and the early/late ratio (r = -0.46, p < 0.01) correlated with tau. When the combination of normal mitral inflow variables with prolonged tau (> or = 50 ms) was classified as pseudonormalization, peak early diastolic mitral annulus velocity < 8.5 cm/s and the early/late ratio < 1 could identify the pseudonormalization with a sensitivity of 88% and specificity of 67%. CONCLUSIONS Mitral annulus velocity determined by DTI is a relatively preload-independent variable in evaluating diastolic function.
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Sohn et al. (1997) conducted an observational in Evaluation of left ventricular diastolic function (n=128). Doppler tissue imaging of mitral annulus velocity vs. Conventional Doppler mitral inflow velocity was evaluated on Correlation of peak early diastolic mitral annulus velocity with time constant of relaxation (tau) (r = -0.56, p=<0.01). Mitral annulus velocity assessed by Doppler tissue imaging correlated with tau (r = -0.56, P<0.01) and identified pseudonormalization with 88% sensitivity and 67% specificity.
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