The assessment of mitral inflow propagation velocity in the diagnosis of advanced left ventricular diastolic dysfunction

Abstract

Background: The echocardiographic assessment of left ventricular diastolic function is usually based on mitral inflow parameters. The main limitation of this method is caused by pseudonormalisation of mitral inflow profile in advanced stages of diastolic dysfunction.

Aim: To evaluate the value of propagation velocity (Vp) of early and atrial mitral inflow wave in the diagnosis of pseudonormalisation.

Methods: We examined 180 subjects (104 males, mean age 58+/-11) by transthoracic echocardiography with the assessment of propagation velocity in colour-M-mode. The studied group consisted of 120 patients with coronary artery disease and 60 healthy controls. The values of E/A (ratio of early to atrial mitral inflow peak velocity) were calculated and subjects with normal (early wave deceleration time, Edt > or =150 ms) and pseudonormal (Edt <150 ms) mitral inflow patterns were identified. Propagation velocities were compared between groups with normal and pseudonormal mitral inflow profiles and optimal cut-off values were estimated.

Results: In the pseudonormal group, velocities of early and atrial propagation were significantly lower than those in the normal group: 25+/-11 vs 46+/-8 cm/s (p<0.001) and 33+/-10 vs 43+/-11 cm/s, (p<0.01), respectively. Both parameters showed the same optimal cut-off value for the diagnosis of pseudonormalisation which was < or =31 cm/s. Sensitivity, specificity and accuracy for the detection of pseudonormal mitral inflow pattern for early wave propagation were 87, 96 and 94%, and for atrial wave propagation - 60, 83 and 78%, respectively.

Conclusions: Decreased value of mitral inflow early wave propagation velocity offers high sensitivity and specificity for the diagnosis of mitral inflow pseudonormalisation. Atrial wave propagation velocity has also potential value for advanced quantitative assessment of diastolic function.