Striking effect of left ventricular high filling pressure with mitral regurgitation on mitral annular velocity during early diastole. A study using colour M-mode tissue Doppler imaging

Abstract

Aims: To evaluate the effect of considerably high left ventricular filling pressure with mitral regurgitation on mitral annular velocity during early diastole. Subjects: Two hundred and forty-three patients who underwent cardiac catheterization for evaluation of chest pain. Methods: Mitral annular velocity during early diastole was measured by colour M-mode tissue Doppler imaging. Patients were divided into the following three groups according to the cardiac catheterization data. Group A (n=147): patients having left ventricular relaxation time constant τ<46 ms and left ventricular end-systolic volume index <38 ml m-2; group B (n=88): patients having τ≥46 ms and/or end-systolic volume index ≥38 ml m-2; group C (n=8): patients having mean pulmonary capillary wedge pressure ≥ 16 mmHg in addition to τ≥46 ms and end-systolic volume index ≥38 ml m-2. Results: Mitral annular velocity during early diastole was significantly less in group B (4.8 ± 1.4 cm s-1) than in group A (7.7 ± 1.9 cm s-1). However, there was no significant difference between groups A and C (8.3 ± 0.8 cm s-1). A transmitral E/A >1.0 was observed in 12/147 patients of group A, 10/88 of group B, and 8/8 of group C. The incidence of ≥Sellers' grade II mitral regurgitation was higher in group C than the others. Conclusions: A paradoxically faster mitral annular velocity during early diastole is found in patients having left ventricular dysfunction with moderate to severe mitral regurgitation and considerably high left ventricular filling pressure. Attention should be paid to an interpretation of mitral annular velocity during early diastole regarding left ventricular early diastolic performance in patients having mitral regurgitation with an E/A >1.0 in their transmitral flow. © 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.