Analysis of mitral anulus motion by tissue Doppler echocardiography (TDE):non-invasive assessment of left ventricular diastolic dysfunction

Background: Mitral inflow velocity, deceleration time, and isovolumic relax ation time recorded by Doppler echocardiography have been widely used to ev aluate left Ventricular diastolic function but are affected by age, heart r ate, loading conditions, and other factors. The diastolic mitral anulus vel ocity assessed by tissue Doppler echocardiography (TDE) was suggested to pr ovide additional information about LV relaxation less affected by filling p ressures. Aim of the study: This study was designed to assess the clinical utility of mitral anulus velocity in the evaluation of left ventricular diastolic fun ction. Patients and methods: Three groups of patients with a systolic ejection fra ction > 45 % were separated: 10 normal volunteers (60 +/- 10 y, CON group), 15 asymptomatic patients with known coronary artery disease (60 +/- 11 y, CAD group) and 15 patients with long term arterial hypertension and heart f ailure symptoms (58 +/- 9 y, HYP group). The mitral inflow profile (E, A, E /A) was measured by pulsed Doppler, and the deceleration time (DT) and the isovolumic relaxation period (IVRT) were calculated Systolic, early, and la te diastolic velocities of the septal mitral anulus (S-T, E-T, A(T), E-T/A( T)) were assessed by pulsed TDE. All study subjects had invasive measuremen ts of left ventricular end diastolic filling pressures during left heart ca theterization. Results: In the AH group, E-T (6.9 +/- 4.8 cm/s) and E-T/A(T) (0.71 +/- 0.2 8) were reduced compared to the CON group (11.7 +/- 4.7 cm/s and 1.11 +/- 0 .36, p < 0.05, respectively) and the CAD group (8.9 +/- 5.4 cm/s and 0.85 /- 0.26, respectively, p = ns). The groups did not differ with respect to t he mitral E/A ratio, the deceleration time and the isovolumic relaxation ti me. LVED in the HYP group (16 +/- 8 mm Hg) was elevated compared to the CON group (8 +/- 3, p < 0.05) and the CAD group (12 +/- 6 mm Hg, p = ns). No c orrelation was found between E-T and LVED (r = 0.26). When the combination of mitral E/A ratio > 1 with LVED greater than or equal to 15 mmHg was clas sified as pseudonormalization, the pseudonormalization could be identified by a peak early diastolic mitral anulus velocity (E-T) < 7 cm/s and an E-T/ A(T) ratio < 1 with a sensitivity of 77 % and a specificity of 88 %. Conclusions: The early diastolic mitral anulus velocity assessed by TDE (E- T) is a preload-independent index of LV relaxation. TDE permits the detecti on of diastolic dysfunction in patients with a pseudonormal mitral inflow a nd elevated filling pressures.