Validity of the dispersion of myocardial velocities in differentiation between ischemic and dilated cardiomyopathy

Differentiation between ischemic and non ischemic cause for left ventricular dysfunction has important therapeutic implication in patients with chronic heart failure. Tissue Doppler imaging [TDI] has provided an objective means to quantify global and regional left ventricular [LV] function with improved accuracy and high reproducibility. The present study aimed to use tissue Doppler imaging of the left ventricle for differentiation between ischemic and dilated cardiomyopathy. A total of 40 subjects were included in this study, 15 patients with ischemic cardiomyapathy [1CM], 15 patients with dilated cardiomyapathy [DCM] and 10 healthy subjects as a control group. All studied subjects underwent 12 lead electrocardiogram transthoracic echocardiographic examination and TDI. The following regional parameters were measured in the four basal LV myocardial segments [lateral, septal, anterior and inferior walls]: myocardial systolic [Sm], early diastolic [Em] and late diastolic [Am] velocities, with calculation of dispersion index of each TDI velocity. Both Sm and Em were significantly lower in patients group than in control group [P<0.05]. The mean dispersion index of Sm in control group was [8%+4%], in ICM group [28%+8.1%] and [14%+7.1%] in DCM group, the Sm dispersion index was higher in patients than in the control group and in 1CM group compared to DCM group [P=0.01]. The mean dispersion index of Em in control group was [14%+9%], in ICM group [31%+11.6%] and [19%+4.4%] in DCM group, the Em dispersion index was higher in ICM group in comparison to control group or DCM groups [P=0.001]. The mean dispersion index of Am in control group was [5%+3%]. in ICM group [28%+11.8%] and [19%+9.6%] in DCM group, the Am dispersion index was higher in both patients groups in comparison to control group [P=0.0001]. Receiver operating characteristic [ROC] analysis showed that Sm dispersion index cut off value of [14%] detected patients with ICM with a sensitivity [73%] and a specificity of [90%] while Em dispersion index cut off value of [22%] could detect ICM patients with a sensitivity [80%] and a specificity [90%]. Both systolic [Sm] and Early diastolic velocity [Em] and dispersion of myocardial velocities[Sm, Em and Am] measured by TDI can help for differentiation between ischemic and dilated cardiomyopathy

Effect of [urografin] on left ventriular diastolic and renal functions after cardiac catheterization

is to evaluate the effects of iodinated contrast media "urografin" on kidney functions and left ventricular diastolic function indices in patients underwent coronary angiography. It included 100 patients with normal kidney function 57 male [57%] and 43 female [43%]. The patients are classified into four groups:- group A: diabetic hypertensive patients, group B: only diabetic patients, group C: only hypertensive patients and group D: non diabetic, non-hypertensive patients. For all patients history taking and clinical examination, standard 12 lead ECG, abdominal ultrasonography to exclude renal medical diseases, Echo-Doppler study before, immediately and 7 days after cardiac catheterization for assessment of left ventricular diastolic functions, and kidney function tests before cardiac catheterization, immediately, 3 days and 7 days after cardiac catheterization. We found an increase in blood urea, serum creatinine and decrease in creatinine clearance [not reaching the significant level] at the first day after contrast administration [P> 0.05]; However, the maximal significant effect of these contrast agent on kidney functions was reached at the third day [P< 0.05] and return to normal at the seventh day [P< 0.05]. Also we found that the level of serum creatinine is maximally changed after three days of contrast administration, where the mean values were 1.11 +/- 0.19 before coronary angiography changed to 1.24 +/- 0.17 immediately after coronary angiography and 1.79+0.13 three days after coronary angiography and 1.27+0.12 after seven days of coronary angiography. It was noted that the level of serum creatinine is increased by 25% or > 0.5 mg/dl from the base line value and decline to nearly normal level after seven days of coronary angiography. The effects of contrast agents on kidney functions were significantly higher in groups [A] and [B] than that of groups [C] and [D] and there was a significant positive correlation between the dose of contrast media and the effect on kidney functions [P< 0.05]. Also, there was a non-significant effect of the radio contrast media on the left ventricular diastolic function indices in the four studied groups [P> 0.05] immediately after and seven days after radio contrast administration. However, there was a non-significant correlation between the dose of contrast media and diastolic function parameters immediately after and seven days after coronary angiography [P> 0.05]. So the effect of radiocontrast agents after coronary angiograpghy on kidney functions is benign and transient starting within 1-2 days reaching the peak at 3-5 days and then returning to base line within 7-10 days. This effect is significantly higher in diabetic hypertensive patients than that in non-diabetic, non-hypertensive patients with positive correlation between the dose of contrast media and kidney functions. However, the ionic contrast media exerts negligible alterations on left ventricular diastolic functions indices

Hemodynamic changes effect on mitral valve area in stenosed mitral valve

dobutamine stress echocardiography is a good tool in assessment of valvular heart disease but it is still underused in MS so this work aimed at detection if MVA can change with changing hemodynamics or not still subject of cutovers. dobutamine stress echo was done for 30 patients with isolated MS in sinus rhythm, MVA measured by both Planimetry and PHT methods at rest and after dobutamine infusion. Result: COP increased by > 50% in 13 patients [group I] and by <50% in 17 patients [group II] MVA by Planimetry increased by [27.3 +/- 10.23%] in group I and by [17 +/- 17.71%] in group II [NS difference] but as regards MVA by PHT shows increase by [43 +/- 29.57%] in group I and by [17.2 +/- 28.7%] in group II significant difference [p < 0.05], with increase in cardiac output important clinical changes [from sever to moderate] in 7 patients by Planimetry and in 5 patients by PHT and from [sever to mild] in 2 patients by PHT. MVA is dynamic and responds to increase in COP inspite these changes are small but clinically significant. Also both Planimetry and PHT are accurate methods in assessing MVA with changing hemodynamics and stress echo is safe and productive technique in MS

Interferon Induced Myocardial Disorders mhepatitis C Virus Patients

Hepatitis C virus [HCV] infection is the most common cause of newly diagnosed chronic liver disease. Prevention of HCV complications can be achieved by antiviral therapy. Cardiovascular complications occurred in clinical trials of interferon. The most common presentations of cardio toxicity were cardiac arrhythmias, dilated cardiomyopathy, symptoms of IHD, and low-level conduction impairment or reversible hypertension. This study aimed to investigate the left ventricular systolic and diastolic functions in hepatitis c virus patients treated by interferon alfa. The study included 50 Egyptian cases infected by Hepatitis C virus and was candidate for treatment by Interferon alpha. After initial cardiac evaluation, IFN-alpha 2b was administered once weekly for 6 months, and cardiac evaluation [medical history, physical examination, ECG, systolic and diastolic function parameters by echocardiography] was performed on the 6th month of therapy. In this study, abnormal findings were detected in some patients: dilated cardiomyopathy, early diastolic dysfunctions, mild thickening of the left ventricle, atrial extra systole, and ST segment depression. All of our results were statistically non significant [p-value >0.05]. There was no significant change or adverse effects due to the virus C itself or Interferon alpha therapy. Findings support the tolerability of human leukocyte Interferon alpha for treatment of patients with chronic hepatitis C

Mitral annular calcification, aortic valve sclerosis and aortic root calcification as a predictor for coronary artery disease

Mitral annular calcification [MAC], aortic valve sclerosis [AVS], and aortic root calcification [ARC] are degenerative disease associated with the same risk factors for CAD. Histological and biochemical studies suggests similarities between the mechanisms involved in the development of [MAC, AVS and ARC] and atherosclerosis, suggesting that various calcification processes are part of the spectrum of atherosclerosis and degenerative diseases. This study aimed at evaluation of MAC, AVS and ARC detected by transthoracic echocardiography as a marker for high prevalence of coronary artery disease and to study there to predict the presence of CAD. This study included 50 patients, 30 males and 20 females with mean age of 57.8 +/- 8.5 years. All Patients were subjected to: Careful History taking and Thorough clinical examination, Resting 12 leads surface ECG, Chest X ray, Laboratory investigation for diabetes mellitus and hyperlipidemias, Exercise stress test, Coronary angiography and Complete Echocardiographic study with special comment on MAC, AVS, ARC and calculation of the Calcium Deposits Score. Subjects were classified into five groups, Group [1]: patients MAC alone, Group [2]: patients with AVS alone, Group [3]: patients with ARC alone, Group [4]: patients with two of the above and Group [5]: with All of the above. There was significant difference between patients with and without MAC as regards the incidence of DM and HPN [P < 0.05]. Also the age was higher in patients with MAC [61.6 +/- 7.6 vs. 57.6 +/- 8.5 years] but this difference did not reach statistically significant level [P > 0.05]. The incidence of three vessel disease was significantly higher in patients with MAC [P < 0.05]. The calculated sensitivity of MAC in prediction of CAD was 50%, specificity was 100%, predictive value positive was 100%, predictive value negative was 33.3% and total accuracy was 60% This relatively low sensitivity means that the absence of MAC could not exclude the presence of CAD but the presence of MAC strongly suggest CAD even Severe CAD can be predicted if there is MAC [increased incidence of three vessel disease in patients with MAC]. There was significant difference between patients with and without AVS as regards the age and sex [P < 0.05]. The incidence of DM [77.8% vs. 64.3%], HPN [69.4% vs. 57.1%] smoking [33.3% vs. 7%] was higher in patients with AVS but these differences did not reach statistically significant level [P > 0.05]. The calculated Sensitivity of AVS for prediction of CAD was 75%, specificity 40%, predictive value positive 83.3% and negative 28.5% and accuracy 68%. There was significant difference between patients with and without ARC as regards the incidence of HPN, single and two vessel disease in coronary angiography [P < 0.05]. Although the patients was older [60.1 + 8.3 vs. 58 + 8.3 years], the incidence of dyslepidemia [86.7% vs. 70%] was higher in patients with ARC than patients without ARC, yet these differences did not reach statistically significant level. The calculated Sensitivity of ARC in prediction of CAD was 65%, specificity 60%, predictive value positive 86.7% and negative 30% and accuracy 64%. There was significant difference between patients with different scores regarding the age, incidence of normal coronary angiography, single vessel, two vessels and three vessel disease in coronary angiography. [P < 0.05] the calculated Sensitivity of calcium deposit score one [stated above in MAC, AVS and ARC], but when there is more than one site of calcification [score 2 and 3] the Sensitivity, specificity, predictive value positive, predictive value negative and accuracy all reach 100% for detecting CAD even in the presence of negative exercise stress test. The presence of MAC, AVS, and/or ARC detected by TTE are simple, noninvasive method for prediction of the presence of CAD with accepted sensitivity, specificity, predictive value positive, predictive value negative and accuracy. And when there is more than one site of calcification [calcium deposit score 2 or 3] the sensitivity, specificity, predictive value positive, predictive value negative and accuracy reach 100% for detection of CAD

Differentiation between transmural and non transmural myocardial infarction using tissue doppler imaging

The natural history and outcome of transmural [TM] and nontransmural myocardial infarction [N TM MI] was known to be significantly different many years ago. However, Neither M-mode nor 2-D Echocardiography can provide information regarding TM distribution of contractile performance. Tissue Doppler Echocardiography [TDE] provides new indices of myocardial functions such as myocardial velocity gradient [MVG] which was found to be an accurate method in the experimental assessment of TM. and N. TM. MI. The present work aims to study myocardial velocities in subendocardial and epicardial layers of the infarct segments by pulsed wave [PW] and tissue Doppler echocardiography in order to investigate the value of systolic and diastolic myocardial velocity gradient in distinguishing transmural myocardial infractions from nontransmural one. Forty patients with first attack acute myocardial infarction [MI] and significant single coronary artery disease [> 70% stenosis] were studied with conventional clinical assessment and trans thoracic Echocardiography [TTE] to assess systolic and diastolic left ventricular function, wall motion abnormalities and tissue Doppler imaging [TDI] parameters for assessment of myocardial velocities [including systolic, diastolic and myocardial velocity gradient] in the epicardial and endocardial layers of myocardium. We found a statistically significant difference in the TDI parameters in the endocardial area between the normal and the infarcted segments in patients with transmural and non transmural myocardial infarction. While in the epicardial area there is a statistical significant difference between the infarcted and the normal segments in patients with Q wave myocardial infarction but there is no significant difference in patients with non Q wave myocardial infarction. This means that TDI can detect the non-uniformity of transmural velocity denoting the presence of viable part [epicardial area] in the hypokinetic segments in the nontransmural myocardial infarction. We also found that there is significant difference in TDI parameters in the infarcted segments [either endocardial or epicardial area] between both groups with more depression of the myocardioal velocity in group I [with non Q wave myocardial infarction]. This could be explained by the presence of more viable myocardium in the area with non transmural infarction with less affection of the velocity. We conclude that TDE might be an applicable and noninvasive modality that can detect the non uniformity of transmural velocity differentiating between transmural and nontransmural MI suggesting that aggressive approaches should be taken to salvage myocardium in such patient

Direct coronary stenting and conventional PTCA followed by coronary stenting comparitive study

Multicenter randomized trials have demonstrated that restenosis and repeat revascularization are reduced and event-free survival at 6 months is increased when elective stent implantation is performed' in carefully selected patients and coronary lesions. Therefore, in the majority of centers intracoronary stent placement is now used in more than 80% of the percutaneous coronary interventional procedures. The standard stent implantation technique includes pre- dilatation of the lesion with a balloon cather followed by stent implantation. The new generation of stents is reliably pre-mounted on high pressure compatible balloons with a very low profile stent delivery system that allows direct stent implantation without pre- dilatation in high proportion of patients who are candidates for. PCI

Aim of the Work: In this work we compare short and long-term [6 months] outcome of direct coronary stenting, with standard PTCA followed by coronary stenting

Subjects and Method: This study included 80 patients with IHD whom were proper candidates for PCI in the form of coronary artery stenting with or without pre- dilatation, patients were divided into two groups: Group [1] Included 40 patients treated by direct coronary stenting technique and Group [2] included 40 patients treated by standard balloon angioplasty and stent implantation. All patients subjected to complete history taking and thorough clinical examination, 12-lead surface ECG, Coronary angiography followed by PCI procedure and stenting with and without predilatation and follow-up repeated clinical evaluation and coronary angiography was done for all patients 6 month's after PCI for detection of restenosis of the dilated vessel

Results: we found no statistically significant difference between the two groups regarding age, sex, prevalence of smoking, hypertension, diabetes mellitus, the family history, history of previous coronary artery disease and cholesterol level. There was no statistically significant difference between both groups regarding lesion morphology before dilatation and after dilatation. And there were no significant difference in maximal inflating pressure. But there was highly. significant difference between both groups regarding mean flouro-time used in both procedure [less flouro-time in group [1]] highly significant difference in total procedural time and amount of dye used in the procedure [less total procedural time and less amount of dye used in the group [1]]. There were no significant difference between two groups regarding procedural complications and follow up complications. Also, there was no significant difference between both groups regarding restenosis rate in the follow up coronary angiography, [restenosis occurred in 11 patients in group [1] 27.5%, and in 13 patients in the group [2] 32.5%]

Conclusion: From this study we concluded that: Direct stenting in selected lesions seems to be safe and feasible procedure. The procedural, in-hospital and long-term clinical and angiographic outcomes are equivalent comparing group [1] with group [2], The demonstrated benefits of direct stenting approach were the reduction of the amount of dye, reduction of fluoro-time, reduction of the total procedure time, saving the balloons of pre-dilatations, so, reduction of the total procedure cost and reduction of radiation exposure risk on intervention team. So, we recommend the use of direct stenting whenever indicated

Mitral / aortic flow velocity time integral ratio; its diagnostic power for identification of haemodynamically signification mitral regurgitation

This study aimed to evaluate the diagnostic power of the simple Doppler index of the mitral/aortic flow velocity time integral [VTI] ratio to identify subjects with haemodynamically significant MR compared with three valid quantitative echocardiographic methods [regurgitant volume, fraction and orifice area]. This work studied 30 patients with MR of different grades and etiologies and 10 healthy volunteers as a control group. All were subjected to complete history taking and clinical examination, ECG, plain X-ray, complete echocardiographic and Doppler examination of the heart and determination of the severity of MR by pulsed wave Doppler [PWD]. The study found that the mitral/aortic flow VTI ratio has accepted sensitivity, specificity, P predictive value and total accuracy in quantitation of the severity of MR compared with the quantitative 2D Doppler methods used for quantitation of the severity of MR. Also, it has the advantage of being a very simple method because in the presence of MR, if the mitral/aortic flow VTI ratio is [0.82 +/- 0.12] the MR is mild, if the ratio is [1.11 +/- 0.20] the MR is moderate and if the ratio is [1.39 +/- 0.29] the MR is severe. It was concluded that the mitral/aortic flow VTI ratio has the diagnostic power to identify subjects with hacmodynamically significant MR. Also, it is a simple and accurate method that can be used for grading of MR, sensitive and valid with accepted total accuracy

Diagnostic value of left ventricular atrioventricular plane displacement in assessment of L.V. systolic function

Several echocardiographic indices applied to evaluate LV function may be not reliable when LV contraction is asymmetrical and require good image quality. Determination of the left ventricular atrioventricular plane displacement [AVPD] has several advantages over traditional methods for the evaluation of left ventricular function. This study aimed to evaluate the left ventricular atrioventricular plane displacement as a new index for assessment of left ventricular systolic function, especially in patients with asymmetrical contraction and to correlate these methods with other echocardiographic-derived LV systolic function indices. This study included 60 patients divided into the following groups: Group A included 20 healthy persons as a control group, 16 males and 4 females with a mean age of 38 +/- 2 9.7 years; group B included 20 patients with ischemic heart disease, 17 males and 3 females with a mean age of 53 +/- 6.9 years and group C included 20 patients with dilated cardiomyopathy, 17 males and 3 females with a mean age of 48 +/- 13-20 years. Multip1e echocardiograms were recorded and selected on the basis of clarity. Measurements included left ventricular AVPD, end diastolic diameter [EDD], end systolic diameter [ESD], FS and EF by Teickholtz and Simpson methods. The study found that systolic atrioventricular plane displacement [AVPD] is an effective index for assessment of both segmental and global left ventricular systolic function and that an AVPD > 10 mm correlates with normal left ventricular systolic function [EF > 50%]. So, the AVPD is a rapid, simple, valuable and noninvasive echocardiographic method for evaluation of left ventricular systolic function

Tricuspid annular motion and velocity as a parameter for right ventricular function in patients with inferior myocardial infarction

The amplitude of tricuspid annular motion was significantly lower in patients with inferior MI compared with patients with anterior MI and healthy individuals. Compared with patients without RV infarction, the tricuspid annular motions was significantly lower in patients with RV infarction. In patients with KV infarction, the systolic velocity peak early diastolic velocity and E/L ratio measured at the KV free wall showed a high significant reduction when compared with other groups. The peak systolic and peak early diastolic velocities of the inter ventricular septum in the infarction groups were significantly lower compared with that in healthy individuals, the decreased systolic velocity was more pronounced in patients with RV infarction. Tricuspid annular motion and tricuspid annular velocity can be used as a simple, rapid and noninvasive tool for assessing RV function after inferior myocardial infarction and to detect and confirm the diagnosis of RV infarction

Diagnostic and prognostic value of ST segment elevation in lead III greater than in lead II in patients with acute inferior wall myocardial infarction

To evaluate the diagnostic and prognostic value of ST segment elevation in lead III greater than lead II in patients with acute inferior myocardial infarction for predicting in hospital mortality and associated RV myocardial infarction, 40 patients with acute inferior myocardial infraction were included in this study. ECG, echocardiography and coronary angiography were performed for all patients. The presence o f ST-segment elevation in lead III lead > II from admission ECC defined the presence of RV infarction with sensitivity of 85.7% and specificity of 89.5%. During the hospital course, the prevalence of heart failure, post infarction angina, conduction defects and mortality were higher in patients with ST-segment elevation in lead III > lead II. The study concluded that ST-segment elevation in lead III more than lead II is more sensitive and specific than V3R, V4R in diagnosis RVMI. It is an excellent screening tool for RVMI given its universal availability on all electrocardiograms. Moreover, ST-segment elevation in lead III more than lead II is a significant predictor of in-hospital mortality and post-MI complications

prospective echocardiographic study of peripartum cardiomyopathy

In this work, nine women diagnosed with peripartum cardiomyopathy were prospectively recruited for a longitudinal echocardiographic study. Severe myocardial dysfunction was defined as left ventricular end- diastolic dimension 60 mm or more plus fractional shortening 21% or less and mild dysfunction was defined as left ventricular end- diastolic dimension <60 mm plus fractional shortening 22% to 24%. Unpaired t tests were used to compare the sample means and Fisher exact test used to compare discrete variables. The results indicated that all women were seen initially for pulmonary edema. Echocardiography showed decreased systolic function in all women. All, but one woman had a diagnosis of either chronic hypertension or preeclampsia. Four women were first seen antepartum and five postpartum [range from one day to two months]. A repeated echocardiography was performed in all women [median eight months, range six weeks to two years]. There was no correlation between antepartum or postpartum presentation and cardiovascular status on the follow-up period

Prediction of servere angiographic coronary artery disease through multivariable probability scoring system based on clinical and exercise test data

This study included 120 patients [98 males and 22 females, their ages ranged from 24-70 years] with suspected coronary artery disease. All candidates were subjected to complete history taking and thorough clinical examination including blood cholesterol level, resting 12-lead surface ECG, exercise stress test and coronary angiography. The patients were randomly divided into a training set and a testing set. The training set included 95 patients [80 males and 15 females], which were divided into 2 groups according to the coronary angiographic result. Group I included patients with significant coronary artery disease defined as >70% narrowing in LAD, circumflex artery, right coronary artery or their major branches or 50% narrowing in the left main coronary artery. The test set included 25 patients [18 males and 7 females with an age ranged from 35-61 years, with a mean age of 48.2 +/- 8 years]. Group I and II were compared as regards the different clinical, exercise and hemodynamic variables and introduced those variables into a step-wise logistic regression analysis for the development of the pretest and post test equations for predicting the presence of CAD in the test set of patients. The study showed that the equation can discriminate the accuracy for the detection of patients with severe coronary artery disease in a given group. It can be used for detecting patients with high probability of coronary artery disease with accepted accuracy, sensitivity, specificity and predictive value compared with other equations. It may be helpful for the detection of patients with coronary artery disease and referring them to the appropriate level of investigation and treatment with superior sensitivity than that of the standard criteria of exercise stress test. So, it will be of a great help in referring the patient to the appropriate level of evaluation and treatment, which will result in selective resource use [only the high-risk patient to be referred to expensive and invasive procedures] and cost saving

Assessment of mitral regurgitation severity by different echo-doppler methods

The aim of this study was to determine a simple and accurate technique in the assessment of mitral regurgitation severity by different qualitative and quantitative echo-Doppler methods. Two qualitative parameters, commonly used, and two quantitative methods in assessing the severity of mitral regurge in cases of central [C] jets and in those with eccentric [E] jets were compared. Forty patients with native, isolated MR of different causes were evaluated using qualitative methods. MR was considered severe if regurgitant fraction [RF] >/60% and regurgitant orifice area [ROA] >/0.4 cm2. The regurgitant jet direction was located in all cases. A significant correlation was found between VC width on one hand and RF and ROA on the other hand in patients with both central [C] and eccentric [E] jets. Although jet area, the most commonly used parameter for assessing MR severity, shows a significant correlation with the degree of mitral regurgitation, this correlation is valid only in patients with central jet and it is of no clinical value in those with eccentric jets

Assessment of myocardial perfusion by harmonic power doppler intermittent imaging and real time Coherent imaging: comparison with SPECT imaging

In this study, 41 patients with suspected or known coronary artery disease were examined by myocardial contrast echocardiography [MCE] using randomly either harmonic power Doppler with intermittent imaging [27 patients] or real time coherent imaging [14 patients] using intravenous Levovist infusion. All patients underwent single photon emission computed tomography [SPECT] after the injection of technetium-99m [Tc-99m] sestamibi or thallium-201 [Th 201] at rest within one to three days of MCE. Both echocardiographic and scintigraphic images were analyzed by two experienced cardiologists in a blinded manner using the same 16-segment model of the left ventricle and the same scale used for perfusion grading. The concordance between MCE [harmonic power Doppler intermittent imaging [HPDI] or real time imaging [RTI]] and SPECT for the detection of segments with normal or abnormal perfusion was analyzed

Intraventricular dispersion of early diastolic filling as a marker of left ventricular diastolic dysfunction

This study was designed to elucidate the hypothesis that peak early diastolic flow velocity decreases progressively from the base to the apex in patients with left ventricular [LV] diastolic dysfunction. In normal subjects, early diastolic flow velocity at mitral tip was maintained at positions of 1 to 3 cm away from the tip into LV cavity. In contrast, regional peak early diastolic flow velocity progressively decreased toward the apex in patients with hypertensive heart disease, aortic stenosis, ischemic heart disease and dilated cardiomyopathy groups. These findings were observed even in patients with a normalized mitral flow velocity pattern or those with AF. Thus, the assessment of intraventricular decrease in peak early diastolic flow velocity may be useful in detecting LV diastolic dysfunction particularly in patients with AF or normalized mitral flow velocity pattern