Additional value of lateral tissue Doppler imaging in the assessment of diastolic dysfunction among subjects with pseudonormal pattern of mitral inflow

• Published in: Cardiovascular ultrasound Vol. 11; no. 1; p. 31
• Main Authors: Kim, Hack-Lyoung, Zo, Joo-Hee, Seo, Jae-Bin, Chung, Woo-Young, Kim, Yong-Jin, Kim, Sang-Hyun, Kim, Myung-A, Sohn, Dae-Won
• Format: Journal Article
• Language: English
• Published: England BioMed Central 20.08.2013; BioMed Central Ltd
• Subjects: Cardiology; Cardiovascular disease; Comorbidity; Echocardiography, Doppler - statistics & numerical data; Elasticity Imaging Techniques - statistics & numerical data; Female; Heart failure; Humans; Male; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - epidemiology; Prevalence; Prognosis; Reproducibility of Results; Republic of Korea - epidemiology; Risk Assessment; Sensitivity and Specificity; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - epidemiology
• ISSN: 1476-7120; 1476-7120
• DOI: 10.1186/1476-7120-11-31

There has been a lack of research on further stratification of subjects who have pseudonormal pattern of mitral inflow. The study aim was to clarify 2 different groups with different diastolic function grades among these subjects using lateral tissue Doppler imaging (TDI). A total of 122 consecutive subjects showing pseudonormal pattern of mitral inflow (E/A ≥ 1 and septal e'/a' < 1) without structural abnormality were prospectively recruited. TDI measurements were performed from both septal and lateral mitral annuli. Study subjects were stratified according to lateral TDI pattern (e'/a' < 1 [n = 50] versus e'/a' ≥ 1 [n = 72]). Subjects with lateral e'/a' < 1 had higher values of left atrial volume index (LAVI) and E/e' compared to those for lateral e'/a' ≥ 1 (p < 0.001 for each). Among subjects with lateral e'/a' ≥ 1, only 9.3% of subjects had grade II diastolic dysfunction, whereas among subjects with lateral e'/a' < 1, majority of subjects (64.1%) had grade II diastolic dysfunction (p < 0.001). Multiple linear regression analysis showed that lateral e'/a' was independently associated with LAVI (β = -0.484, p < 0.001), even after adjusting for potential confounders including age, sex, body mass index, hypertension and diabetes. In subjects without structural abnormality showing E/A ≥ 1 and septal e'/a' < 1, lateral TDI measurement is useful in the assessment of diastolic dysfunction. Lateral e'/a' ≥ 1 is a valuable indicator of early diastolic dysfunction but not of advanced diastolic dysfunction in this population.