Tissue Doppler imaging: A new technique for assessment of pseudonormalization of the mitral inflow pattern

Left ventricular diastolic dysfunction (LVDD) is a frequent cause of heart failure. Doppler echocardiography has become the method of choice for the n oninvasive evaluation of LVDD. However pseudonormalization (PN) of the mitr al inflow often presents a diagnostic challenge in, clinical practice. In t his setting, we sought to define the role of tissue Doppler imaging (TDI) o f the septal mitral annulus. Echocardiography was performed in 36 consecuti ve subjects (age 59 +/- 10 years). Eighteen of these had diagnosed coronary artery disease (CAD) with recent onset of symptoms (within 3 months), 18 h ad clinical suspicion of CAD, and 15 had symptoms of heart failure (New Yor k Heart Association [NYHA] Class 2.4 +/- 0.5). The mitral inflow profile (E , A, E/A) was measured by pulsed Doppler, and the deceleration, time (DT) a nd the isovolumic relaxation time (IVRT) were calculated. Peak diastolic ve locities of the septal mitral annulus (E-T, A(T), E-T/A(T)) and the time in terval from Q in the ECG to the onset of E-T were derived from pulsed TDI L eft heart catheterization was performed for direct measurement of left vent ricular end-diastolic pressure (LVEDP). PN defined by an EIA ratio > 1 and art LVEDP greater than or equal to 16 mmHg was found in nine patients. All patients with PN had symptoms of heart failure (NYHA Class 2.8 +/- 0.5). Pa tients with and without PN did not differ with respect to the EIA ratio (1. 29 +/- 0.44 vs 1.16 +/- 0.23, P = ns), DT (182 +/- 38 msec vs 205 +/- 42 ms ec, P = ns), and IVRT (88 +/- 24 msec us 92 +/- 18 msec, P = ns). In the gr oup with PN, a significant reduction of E-T (5.6 +/- 1.8 cm/sec vs 8.8 +/- 2.9 cm/sec, P < 0.05) and E-T/A(T) (0.5 +/- 0.16 vs 0.82 +/- 0.37, P < 0.05 ) was detected. In the PN group, the Q-E-T interval was prolonged (404 +/- 48 msec vs 346 +/- 50 msec, P < 0.05). Receiver operating characteristic cu rve analysis for E,yielded an area under the cw ve of 0.78 +/- 0.06 (P = 0. 034) for separating patients with versus without PN. When the combination o f E-T < 7 cm/sec and E-T/A(T) < 1 was used as cutpoint, PN could be identif ied with a sensitivity of 83% and a specificity of 79%. There was no signif icant relation between LVEDP and either E-T (r = 0.32, P > 0.2) or the Q-E- T interval (r = 0.14, P > 0.5). In conclusion, ET and the Q-E-T, interval a ppear to be useful parameters for assessing LV diastolic dysfunction in sym ptomatic patients with a pseudonormal mitral inflow pattern and elevated fi lling pressures.