EFFECTS OF LEFT-VENTRICULAR SYSTOLIC FUNCTION ON LEFT-VENTRICULAR DIASTOLIC FILLING PATTERNS IN SEVERE MITRAL REGURGITATION

Significant mitral regurgitation (MR) may alter the normal pattern of Doppler detected left ventricular (LV) filling by causing a prominent early filling (E) wave velocity. The manner and extent to which the ty pical filling pattern of uncomplicated MR is affected by concomitant i mpaired LV systolic function has not been characterized. Twenty patien ts with severe LV systolic dysfunction (2-dimensional echocardiographi c estimation of election fraction less than or equal to 30%) and 21 ag e- and sex-matched case controls with normal systolic function (ejecti on fraction greater than or equal to 55%) were selected. In addition, 20 subjects with normal LV systolic function and no MR were analyzed a s a reference group. Maximal E-wave velocity was increased and highest among MR patients with preserved LV systolic function (124 +/- 37 cm/ s) than among those with LV systolic dysfunction (101 +/- 25 cm/s; p < 0.05) and normal controls (74 +/- 18 cm/s; p < 0.001). Concurrently, A-wave velocity was lowest in patients with systolic dysfunction and M R (47 +/- 23 cm/s; p < 0.001) than in patients with normal systolic fu nction and MR (79 +/- 33 cm/s) and normal controls (74 +/- 20 cm/s). D eceleration time of the E wave was longest among those with normal sys tolic function and MR (203 +/- 41 ms) than among those with systolic d ysfunction and MR (152 +/- 35 ms; p < 0.001) and normal controls (167 +/- 53 ms; p < 0.05). Thus, systolic LV dysfunction in patients with s evere MR, compared to patients with MR and normal LV systolic function , is associated with important changes in diastolic inflow velocities, including reduction of the maximal A-wave velocity to a greater exten t than the E wave, resulting in an increased E/A ratio and shortening of deceleration time of the E wave. (C) 1997 by Excerpta Medica, Inc.