Differentiation of abnormal relaxation pattern with aging from abnormal relaxation pattern with coronary artery disease in transmitral flow with the use of tissue Doppler imaging of the mitral annulus

An abnormal relaxation pattern in transmitral now velocity waveforms has be en observed in older healthy subjects as well as in patients with heart dis ease. Accordingly, we investigated whether the hemodynamic differences betw een patients with coronary artery disease (CAD) with an abnormal relaxation pattern in transmitral flow (ratio of E-wave to A-wave velocities < 1.0) a nd healthy older subjects with an abnormal relaxation pattern can be distin guished with the use of mitral annular velocity (MAV) during early diastole . We measured MAV in the longitudinal direction of the heart during early d iastole by M-mode color tissue Doppler imaging in 24 patients with atypical chest pain (defined as healthy subjects in this study) and 70 patients wit h CAD who underwent cardiac catheterization. In all patients a time constan t of left ventricular pressure decay (tau) and the left ventricular (LV) en d-systolic volume index were also measured. Twenty-one healthy subjects and 59 patients with CAD had an abnormal relaxation pattern in their transmitr al flow. The age, heart rate, mean blood pressure, and ratio of E-wave to A -wave velocities were not different between the two groups. However, the ta u was longer and the LV end-systolic volume index was greater in patients w ho had an abnormal relaxation pattern with CAD than in healthy subjects wit h an abnormal relaxation pattern. The MAV during early diastole was lower i n the former than in the latter (5.8 +/- 1.3 vs 9.8 +/- 1.9 cm/s, P < .001) . Mitral annular velocity during early diastole by M-mode color tissue Dopp ler imaging can detect the differences in LV relaxation and LV systolic per formance between the abnormal relaxation pattern with CAD and the physiolog ically abnormal relaxation pattern with aging, providing further informatio n regarding the meaning of an LV abnormal relaxation pattern.