DOPPLER STUDY OF TRANSMITTED TRANSMITRAL A-WAVE IN PATIENTS WITH A 4TH HEART-SOUND

To investigate the characters of the transmitted transmitral A wave as sociated with a fourth heart sound left ventricular inflow, and outflo w Doppler echocardiography and phonocardiography were recorded in 13 p atients with a fourth heart sound and 9 age-matched control subjects. The Doppler echocardiographic data were compared between both groups a nd the peak velocity and acceleration rate of the transmitted transmit ral A wave were correlated with other parameters. The peak velocity an d acceleration, rate of the transmitted transmitral A wave were signif icantly greater, but the A wave transit time from the mitral valve to the left ventricular outflow tract (A-Ar interval) was significantly s horter in patients with a fourth heart sound. There was a significant correlation between the A-Ar interval and the peak velocity (r = -0.54 , P = 0.01) or acceleration. rate (r = -0.63, P = 0.002) of the transm itted transmitral A wave. The A-Ar interval was shown to be the indepe ndent determinant of both the peak velocity and acceleration rate of t he transmitted transmitral A wave by stepwise multiple linear regressi on. In conclusion the presence of a fourth heart sound was associated with a higher peak velocity and acceleration rate of the transmitted t ransmitral A wave, to which increased ventricular stiffness may make s ome contributions.