Doppler tissue imaging of the mitral annulus in patients with left ventricular systolic dysfunction. Assessment of diastolic function

Introduction and objectives. We assessed the Doppler tissue imaging techniq ue in the left mitral annulus of patients with left ventricular systolic dy sfunction since the technique has been used to evaluate diastolic function of the left ventricle and the values obtained have been considered to be re latively independent of the preload. Patients and methods. Patients (n = 46) with an ejection fraction < 40% in sinus rhythm without mitral regurgitation underwent pulsed wave Doppler ana lyses of mitral inflow (E and A waves), pulmonary venous flow (S, D and Ar waves) and Doppler tissue imaging of the mitral annulus (Ea and Aa waves). Results. Overall, the linear correlations between the different Doppler mea surements were poor. When subgrouped with respect to E/A < 1 and E/A greate r than or equal to 1 (Groups 1 and 2, respectively), the Ea value did not s ignificantly differ between the two groups: 5.0 cm/s (4.2/6.0) vs 6.2 cm/s (5.5/8.2) respectively; p = 0.129 and neither did the E/Ea quotient: 10.2 ( 8.2/14.5) vs 12.9 (9.1/17.4) respectively; p = 0.160. Atrial size was signi ficantly greater in Group 2: 20.0 cm(2) (18.0/22.0) vs 25.0 cm(2) (20.0/29. 0) respectively; p = 0.000. The Ea/Aa quotient was pseudo-normalized in Gro up 2: 0.65 (0.48/0.83) vs 1.15 (0.75/1.71) respectively; p = 0.001. Conclusion. In patients with left ventricular systolic dysfunction the Ea/A a value tends towards pseudo-normalization when the preload is increased. T his does not apply to the values of Ea, E/Ea or to size of the left atrium. Therefore, Doppler tissue imaging of the left mitral annulus is valuable i n the assessment of left ventricular dysfunction and the problem of pseudo- normalization due to preloading.