M-mode analysis of mitral annulus motion for detection of pseudonormalization of the mitral inflow pattern

left ventricular (LV) diastolic dysfunction is a frequent cause of heart fa ilure. Doppler echocardiography has become the method of choice for the non invasive evaluation of LV diastolic dysfunction. However, pseudonormalizati on of mitral inflow often presents a diagnostic problem in clinical practic e. We sought to define the role of mitral annulus motion in this setting. W e performed echocardiography in 36 consecutive subjects (age 59 +/- 10 year s). Eighteen had recently (within 3 months) been diagnosed with coronary ar tery disease, 18 had clinical suspicion of coronary artery disease, and 15 had symptoms of heart failure (New York Heart Association class 2.4 +/- 0.5 ). The amplitude (EM) and the slope (slope E) of early diastolic motion of the septal mitral annulus were derived from M-mode analysis. Left heart cat heterization was performed for direct measurement of LV enddiastolic pressu re. Pseudonormalization defined by an E/A ratio >1 and a LV end-diastolic p ressure greater than or equal to 16 mm Hg was found in 9 patients. All pati ents with pseudonormalization were symptomatic (New York Heart Association class 2.8 +/- 0.5). Patients with and without pseudonormalization did not d iffer with respect to the E/A ratio (1.29 +/- 0.44 vs 1.16 +/- 0.23, p = NS ), deceleration time (182 +/- 38 vs 205 +/- 42 ms, p = NS), and isovolumic relaxation time (88 +/- 24 vs 92 +/- 18 ms, p = NS). In the group with pseu donormalization, a significant reduction of E-M (3.9 +/- 1.6 vs 5.7 +/- 1.5 mm, p = 0.008) and slope E (24.5 +/- 11.8 vs 43.9 +/- 7.7 mm/s, p <0.001) was detected. Using E-M <4.3 mm and slope E <35 mm/s as cut points, sensiti vity and specificity for the detection of pseudonormalization were 66% and 82% for E-M and 77% and 87% for slope E, respectively. There was no signifi cant relation between LV end-diastolic pressure as a measure of preload and either E-M (r = 0.44, p >0.5) or slope E (r = 0.30, p >0.2). Thus, E-M and slope E may be preload-independent tools for assessing LV diastolic dysfun ction in symptomatic patients with a pseudonormal mitral inflow pattern and elevated filling pressures. (C) 1999 by Excerpta Medica, Inc.