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. 2022 Sep;63(9):817-824.
doi: 10.3349/ymj.2022.63.9.817.

Associations between Subclinical Myocardial Dysfunction and Premature Fusion of Early and Late Diastolic Filling with Uncertain Cause

Kyu Kim  1 , Jiwon Seo  2 , Iksung Cho  1 , Eui-Young Choi  2 , Geu-Ru Hong  1 , Jong-Won Ha  1 , Se-Joong Rim  2 , Chi Young Shim  3
Affiliations

Associations between Subclinical Myocardial Dysfunction and Premature Fusion of Early and Late Diastolic Filling with Uncertain Cause

Kyu Kim et al. Yonsei Med J. 2022 Sep.

Abstract

Purpose: The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is often found during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clinical implications of premature E-A fusion of uncertain cause in the absence of tachycardia.

Materials and methods: We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between January 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates less than 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) were compared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion.

Results: The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV diastolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msec vs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%, p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred at lower heart rate, the |LV GLS| was also lower (p for trend=0.002).

Conclusion: Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based indices and LV GLS are helpful for evaluating this easily overlooked population.

Keywords: Heart failure; diastole; doppler echocardiography; left ventricular dysfunction.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Representative cases of premature E and A wave fusion. (A) Patients with premature E-A fusion. (B) Patients with E-A fusion due to tachycardia.
Fig. 2
Fig. 2. Comparison of echocardiographic findings between premature fusion and matched controls. (A) Absolute value of LV GLS (%). (B) Tei index. (C) Isovolumic relaxation time (msec). (D) LV mass index (g/m2). LV, left ventricular; GLS, global longitudinal strain.
Fig. 3
Fig. 3. Trends in left ventricular (LV) global longitudinal strain (GLS) according to the heart rate at which fusion occurred.
See this image and copyright information in PMC

References

    1. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: part I. Diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002;105:1387–1393. - PubMed
    1. Kitzman DW, Little WC. Left ventricle diastolic dysfunction and prognosis. Circulation. 2012;125:743–745. - PMC - PubMed
    1. Nagueh SF. Left ventricular diastolic function: understanding pathophysiology, diagnosis, and prognosis with echocardiography. JACC Cardiovasc Imaging. 2020;13(1 Pt 2):228–244. - PubMed
    1. Marwick TH, Gimelli A, Plein S, Bax JJ, Charron P, Delgado V, et al. Multimodality imaging approach to left ventricular dysfunction in diabetes: an expert consensus document from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2022;23:e62–e84. - PubMed
    1. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, 3rd, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016;29:277–314. - PubMed