Systolic Mitral Annular Velocity as a Simple Marker of Left Ventricular Peak Systolic dP/dt in Patients with Significant Mitral Regurgitation

BACKGROUND: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S') can be a good marker of LV dP/dt. METHODS: We studied 62 patients (25 men, age: 47+/-15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S' velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. RESULTS: Mean LV ejection fraction was 60+/-6% and regurgitant fraction was 59+/-15%. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S' velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. CONCLUSION: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.

Mitral annular velocity by Doppler tissue imaging for evaluation of left ventricular diastolic function / 대한내과학회지

BACKGROUND: Doppler echocardiography is widely used for the noninvasive evaluation of left ventricular diastolic function. However the mitral flow velocity pattern is affected by several physiologic factors. The mitral annular velocity profile by Doppler tissue imaging may provide more additional information about left ventricular diastolic function. Thus, this study designed to assess the relationship between cardiac catheterization, MUGA scan, mitral flow velocity, and mitral annular velocity data and to assess the clinical availavility of mitral annulus velocity in the evaluation of left ventricular diastolic function. METHODS: The study population consisted of 20 patients with dilated cardiomyopathy( 64+/-7years), 20 patients with normal left ventricular function (61+/-7years). Left ventricular catheterization was performed with fluid-filled catheter and left ventricular end diastolic pressure, -dP/dtmax were measured. The mitral flow velocity was recorded at mitral valve tip and the mitral annulus velocity during diastole was measured by Doppler tissue imaging(DTI). Simultaneously EF(ejection fraction), PER(Peak filling rate), PFR(Peak filling rate) were measured by MUGA blood pool scan. RESULTS: Mean peak E velocity, mean peak A velocity, E/A ratio, mean peak E' velocity, mean peak A' velocity, E'/A' ratio and -dP/dtmax significantly difference betweeen two group. -dP/dtmax by cardiac catheterization showed significant correlation with mean peak E' velocity (r=0.552, p=0.003), E'/A' ratio(r=0.507, p=0.003), DT of E'(r=-0.556, p=0.001), TVI of E'(r=0.689, p<0.001) and DT of E wave(r=-0.538, p=0.003). PFR by MUGA scan also showed significant correlation with -dP/dtmax(r=0.537, p=0.01). CONCLUSION: Among mitral annulus velocity index mean peak E' velocity, E'/A' ratio, DT of E',TVI of E' had significant correlation with -dP/dtmax. And DT by mitral flow velocity, PFR by MUGA scan also had significant correlation with -dP/dtmax. Mitral annulus velocity determined by DTI is relatively convenient, safe, and preload-independent variable in evaluating diastole function. Thus mitral annulus velocity by Doppler tissue imaging is may be useful diagnostic modality for evaluating left ventricular diastolic function.

Assessment of Diastolic Function Using Mitral Annulus Velocity by Doppler Tissue Velocity in the Patients with Left Ventricular Hypertrophy

BACKGROUND AND OBJECTS: Mitral annulus velocity by Pulsed Wave Doppler has been used as method of evaluation of left ventricular diastolic function. However, it is unknown how this is altered in the patients with left ventricular hypertrophy (LVH). this study was aimed to compare a group of healthy subjects with a group of patients with LVH. METHODS: Subjects were 80 patients with LVH (left ventricular mass index125 g/m2) and 163 controls with normal left ventricular mass index (<125 g/m2). For measuring the mitral annulus velocities by doppler tissue imaging (=DTI), we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjects. in LVH group, mitral annulus E've#locity was significantly lower than controls (5.2+/-1.3 cm/sec vs 6.2+/-1.7 cm/sec, p(<0.001) and mitral annulus A' velocity was also significantly higher than controls (8.5+/-1.3 cm/sec vs 8.0+/-1.1 cm/sec, p<0.02). annular displacement measured by DTI-TVI (time velocity integral), also In LVH group, mitral annulus E'-TVI was significantly lower than controls (5.7+/-1.8 mm vs 6.8+/-2.2 mm, p<0.001). CONCLUSION: Mitral annulus velocity determined by DTI could be used as one of the parameters in evaluating diastolic function in patient with LVH.

Mitral Annulus Velocity Measured by Pulsed Wave Doppler Tissue Imaging in Healthy Korean People

BACKGROUNS AND OBJECTIVES: Mitral annulus velocity measured by Pulsed Wave Doppler Tissue Imaging has been used as method of evaluation of left ventricular diastolic function. However, there are few reports of mitral annulus velocity measured by doppler tissue imaging in healthy normal people. the puopose of this study is to know normal values of mitral annulus velocity in healthy korean people. SUBJECTIVES AND METHODS: Subjectives were 100 healthy normal korean (men : 58 and women : 42 average : 51+/-7, range : 41-67) without hyper-tension and heart disease. subjectives were divided three groups according to age, group I which are forties (n=42), group II which are fifties (n=46), and group III which are sixties (n = 14). For measuring the mitral annulus velocities by DTI, we used the 2.5 MHz probe (Sequoia, Accuson) in apical 4 chamber view with the sample volume at the septal portion of the mitral annulus. RESULTS: Mitral annular velocity in diastole is easily recorded by DTI in all subjectives. mitral annulus E'velocities were significantly decrease with aging (group I * 7.5+/-l.3 cm/sec, group II 5.7+/-1.3 cm/sec, group III 5.1+/-1.3 cm/sec. *p <0.001 in group I vs group lI and group I vs group III ) and also E'/A' ratios were significantly decrease with aging (group I * 1.0+/-0.2, group #II 0.8+/-0.2, group III 0.6+/-0.2. *p<0.001 in group I vs group ll and group I vs group III). mitral annulus A' velocities were increase with aging but has no statistical significance (group I 7.8+/-1.0 cm/sec, group II 7.9+/-1.2 cm/sec, group III 8.3+/-0.8 cm/sec. p=NS). mitral annulus E'velocities were correlated with age (r=-0.686, p <0.01) CONCLUSION: This results shows that mitral annulus E'velocities and E'/A' ratios were significantly decrease with aging and mitral annulus A' velocities were increase with aging, also there are good correlation between mitral annulus E' velocities and aging.

Comparison between Mitral Flow and Mitral Annulus Velocity by Doppler Tissue Imaging according to Increment of Heart Rate

BACKGROUND AND OBJECTIVES: The utility of Doppler mitral flow pattems for the indirect assessment of left ventricular diastolic function is valid and widely used. One of the most common variables affecting mitral flow is heart rate. The aim of this study was to compare between mitral flow and mitral annulus velocity by Doppler tissue imaging (DTI) according to increment of heart rate. MATERIALS AND METHODS: 17 healthy volunteers (M: F=10: 7, mean age 27+/-2 years) comprised this study. They were free of any acute or chronic illness. The heart rate was elevated by increments of 10 beats (baseline, 80, 90, 100, 110, 120) by transesophageal atrial pacing. We measured mitral flow parameters (E and A velocity, E/A ratio, IVRT, DT of E) and mitral annulus velocity by DTI (e and a velocity, e/a ratio, RIVRT). We gave the score of visual estimation at baseline and each heart rate. The definition of the score was as follows, 1: well visualization of each envelope 2: summation of velocity wave forms 3: no differentiation, completely fused. RESULTS: 1) The E of mitral flow was significantly increased from 100 to 120 BPM and A velocity was significantly increased from 80 to 100 BPM (p<0.05). E/A ratio was significantly decreased from 90 to 100 BPM than baseline (p<0.05). 2) The e and e/a ratio of mitral annulus velocity were significantly increased from above 110, 100 BPM than baseline, respectively (p<0.05). But a velocity was little changed. 3) The score was all significantly higher in mitral annulus velocity pattern by DTI than mitral flow at each heart rate. CONCLUSIONS: The mitral annulus velocity by DTI is less affected by heart rate and visualized better than mitral fiow in increased heart rate. Therefore the assessment of mitral annulus velocity may be helpful for evaluating diastolic function during heart rates of physiologic range.

Clinical Utility of Mitral Annulus Velocity to Estimate Left Ventricular Filling Pressure

BACKGROUND: Early mitral inflow velocity(E) corrected for the influence of LV relaxation could give information about LV filling pressure. Early diastolic mitral annulus velocity(E') is a relatively load independent parameter reflecting LV relaxation. Therefore, correction for the influence of LV relaxation could be done with the ratio of early mitral inflow velocity to early mitral annulus velocity(E/E'). The aim of this study was to investigate the clinical utility of E/E' ratio in a large number of patients. METHODS: Simultaneous left ventricular pressure measurements and Doppler examinations were performed in 200 consecutive patients at the cardiac catheterization laboratory. RESULTS: E/E' ratio correlated well with pre-A pressure(r=0.74, p or =50%; r=0.74, p12mmHg) pre-A pressure with the sensitivity of 81% and specificity of 80%. LV pre-A pressure could be estimated with the simplified equation of [pre-A pressure=E/E'+4]. CONCLUSIONS: E/E' ratio is useful in the estimation of LV filling pressure and in contrast to the conventional parameters, it is not dependent on the left ventricular systolic function.