LEFT-VENTRICULAR DOPPLER FILLING PATTERN IN DILATED CARDIOMYOPATHY - RELATION TO HEMODYNAMICS AND LEFT ATRIAL FUNCTION

This study attempted to examine the relation of left ventricular filli ng patterns to hemodynamic status and left atrial function in dilated cardiomyopathy. Transesophageal echocardiography and cardiac catheteri zation were performed in 41 patients with dilated cardiomyopathy (six with an ischemic origin). Transmitral, left atrial appendage, and pulm onary venous flow velocities were recorded with the pulsed Doppler met hod. Left atrial systolic function was assessed by the peak velocity o f the left atrial appendage emptying wave and pulmonary venous flow re versal during atrial systole. Patients were classified into three grou ps according to their left ventricular filling patterns. Group 1 showe d an abnormal relaxation pattern (E wave/A wave ratio <1, n = 17), gro up 2 had a normal or pseudonormal pattern (1 less than or equal to E/A < 2, n = 11), and group 3 had a restrictive pattern (E/A greater than or equal to 2, n = 13). No differences were found among the groups wi th regard to age, gender, heart rate, and M-mode echocardiographic ind ices of left ventricular function. Compared with patients in group 1, those in groups 2 and 3 had more symptoms (New York Heart Association functional class III or TV) and had higher left ventricular filling pr essures. The sensitivity of an E/A ratio greater than or equal to 1 fo r predicting a pulmonary capillary wedge pressure greater than or equa l to 15 mm Hg was 75% and the specificity was 94%. Despite a similar i ncrease of filling pressures, group 3 patients had a lower left atrial appendage emptying velocity, pulmonary venous flow reversal velocity, and mitral A velocity than did group 2 patients. The sensitivity and specificity of an E/A ratio greater than or equal to 2 for detecting l eft atrial dysfunction (left atrial appendage emptying velocity less t han or equal to 40 cm/sec) was 85% and 86%, respectively. In conclusio n, among patients with dilated cardiomyopathy , those who had a restri ctive or pseudonormal filling pattern were in a higher functional clas s and had higher filling pressures. Further studies are needed to dete rmine the therapeutic and prognostic significance of left atrial dysfu nction, which was common in patients with a restrictive pattern.