Differentiation of abnormal relaxation pattern with aging from abnormal relaxation pattern with coronary artery disease in transmitral flow with the use of tissue Doppler imaging of the mitral annulus.

An abnormal relaxation pattern in transmitral flow velocity waveforms has been observed in older healthy subjects as well as in patients with heart disease. Accordingly, we investigated whether the hemodynamic differences between patients with coronary artery disease (CAD) with an abnormal relaxation pattern in transmitral flow (ratio of E-wave to A-wave velocities < 1.0) and healthy older subjects with an abnormal relaxation pattern can be distinguished with the use of mitral annular velocity (MAV) during early diastole. We measured MAV in the longitudinal direction of the heart during early diastole by M-mode color tissue Doppler imaging in 24 patients with atypical chest pain (defined as healthy subjects in this study) and 70 patients with CAD who underwent cardiac catheterization. In all patients a time constant of left ventricular pressure decay (tau) and the left ventricular (LV) end-systolic volume index were also measured. Twenty-one healthy subjects and 59 patients with CAD had an abnormal relaxation pattern in their transmitral flow. The age, heart rate, mean blood pressure, and ratio of E-wave to A-wave velocities were not different between the two groups. However, the tau was longer and the LV end-systolic volume index was greater in patients who had an abnormal relaxation pattern with CAD than in healthy subjects with an abnormal relaxation pattern. The MAV during early diastole was lower in the former than in the latter (5.8 +/- 1. 9 vs 9.8 +/- 1.9 cm/s, P <.001). Mitral annular velocity during early diastole by M-mode color tissue Doppler imaging can detect the differences in LV relaxation and LV systolic performance between the abnormal relaxation pattern with CAD and the physiologically abnormal relaxation pattern with aging, providing further information regarding the meaning of an LV abnormal relaxation pattern.

[1]  J. Weiss,et al.  Hemodynamic determinants of the time-course of fall in canine left ventricular pressure. , 1976, The Journal of clinical investigation.

[2]  W A Mandarino,et al.  Color-coded measures of myocardial velocity throughout the cardiac cycle by tissue Doppler imaging to quantify regional left ventricular function. , 1996, American heart journal.

[3]  J. Seward,et al.  The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. , 1997, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[4]  D. Brutsaert,et al.  Diastolic failure: pathophysiology and therapeutic implications. , 1993, Journal of the American College of Cardiology.

[5]  W. Kuebler,et al.  Determination of left ventricular filling parameters by pulsed Doppler echocardiography: a noninvasive method to predict high filling pressures in patients with coronary artery disease. , 1988, American heart journal.

[6]  M. Yamagishi,et al.  New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. , 1995, Journal of the American College of Cardiology.

[7]  R L Popp,et al.  Relation of Transmitral Flow Velocity Patterns to Left Ventricle Diastolic Function: New Insights From a Combined Hemodynamic and Doppler Echocardiographic Study , 1988, Journal of the American College of Cardiology.

[8]  H. Kennedy,et al.  Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. , 1987, Journal of the American College of Cardiology.

[9]  H. Feigenbaum,et al.  Movement of the mitral ring: a study in ultrasoundcardiography. , 1967, Cardiovascular research.

[10]  Y Ishida,et al.  Left ventricular filling dynamics: influence of left ventricular relaxation and left atrial pressure. , 1986, Circulation.

[11]  R. Walsh,et al.  Mechanisms, diagnosis, and treatment of diastolic heart failure. , 1995, American heart journal.

[12]  Jean Charles Gilbert,et al.  Determinants of left ventricular filling and of the diastolic pressure-volume relation. , 1989, Circulation research.

[13]  N. Ohte,et al.  Evaluation of left ventricular early diastolic performance by color tissue Doppler imaging of the mitral annulus. , 1998, The American journal of cardiology.

[14]  C. Chapman,et al.  Use of Biplane Cinefluorography for Measurement of Ventricular Volume , 1958, Circulation.

[15]  J. Gardin,et al.  Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy. , 1986, The American journal of cardiology.

[16]  T. Wakatsuki,et al.  Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation. , 1997, The American journal of cardiology.

[17]  H. Izawa,et al.  Age-related changes in left and right ventricular filling velocity profiles and their relationship in normal subjects. , 1993, American heart journal.

[18]  B. Maron,et al.  Influence of aging on Doppler echocardiographic indices of left ventricular diastolic function. , 1988, British heart journal.

[19]  J. Gardin,et al.  Left ventricular filling in hypertrophic cardiomyopathy: a pulsed Doppler echocardiographic study. , 1986, Journal of the American College of Cardiology.

[20]  C. Lillehei,et al.  LEFT RETROGRADE CARDIOANGIOGRAPHY IN ACQUIRED CARDIAC DISEASE: TECHNIC, INDICATIONS AND INTERPRETATIONS IN 700 CASES. , 1964, The American journal of cardiology.

[21]  R. Bonow,et al.  Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in patients with hypertrophic cardiomyopathy. , 1987, Journal of the American College of Cardiology.

[22]  J. Thomas,et al.  Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. , 1996, American heart journal.

[23]  K. Miyatake,et al.  Augmentation of atrial contribution to left ventricular inflow with aging as assessed by intracardiac Doppler flowmetry. , 1984, The American journal of cardiology.

[24]  N. Ohte,et al.  Diastolic mitral annular motion in normal subjects and patients with coronary artery disease. , 1995, European heart journal.

[25]  Mario J. Garcia,et al.  Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. , 1996, American heart journal.

[26]  W. Grossman,et al.  Diastolic dysfunction in congestive heart failure. , 1991, The New England journal of medicine.

[27]  H. Sawada,et al.  Noninvasive assessment of left and right ventricular filling in myocardial infarction with a two-dimensional Doppler echocardiographic method. , 1985, Journal of the American College of Cardiology.

[28]  A. Weyman,et al.  Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. , 1987, Journal of the American College of Cardiology.

[29]  J Gorcsan,et al.  Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. , 1996, The American journal of cardiology.