M-mode analysis of mitral annulus motion for detection of pseudonormalization of the mitral inflow pattern - 08/09/11
, Axel Schmermund, MD a, Daniela Marin, MD a, Stephanie Kuntz, MD a, Thomas Bartel, MD a, Johannes Schaar, MD a, Raimund Erbel, MD aAbstract |
Left ventricular (LV) diastolic dysfunction is a frequent cause of heart failure. Doppler echocardiography has become the method of choice for the noninvasive evaluation of LV diastolic dysfunction. However, pseudonormalization of mitral inflow often presents a diagnostic problem in clinical practice. We sought to define the role of mitral annulus motion in this setting. We performed echocardiography in 36 consecutive subjects (age 59 ± 10 years). Eighteen had recently (within 3 months) been diagnosed with coronary artery 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 catheterization was performed for direct measurement of LV end-diastolic pressure. Pseudonormalization defined by an E/A ratio >1 and a LV end-diastolic pressure ≥16 mm Hg was found in 9 patients. All patients with pseudonormalization were symptomatic (New York Heart Association class 2.8 ± 0.5). Patients with and without pseudonormalization did not differ 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 pseudonormalization, a significant reduction of EM (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 EM <4.3 mm and slope E <35 mm/s as cut points, sensitivity and specificity for the detection of pseudonormalization were 66% and 82% for EM and 77% and 87% for slope E, respectively. There was no significant relation between LV end-diastolic pressure as a measure of preload and either EM (r = 0.44, p >0.5) or slope E (r = 0.30, p >0.2). Thus, EM and slope E may be preload-independent tools for assessing LV diastolic dysfunction in symptomatic patients with a pseudonormal mitral inflow pattern and elevated filling pressures.
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Vol 84 - N° 6
P. 692-697 - septembre 1999 Retour au numéro
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- Effect of glycemic control on heart rate variability in type I diabetic patients with cardiac autonomic neuropathy
- Andrew J Burger, Larry A Weinrauch, John A D’Elia, Doron Aronson
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