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Doppler Study of Transmitted Transmitral A Wave in Patients with a Fourth Heart Sound
Wen-Chol Voon1, Sheng-Hsiung Sheu, Yuh-Yau Hwang
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical College, No. 100, Shih-Chuan 1st Road, Kaohsiung City 807, Taiwan.
Insights
A fourth heart sound is linked to faster transmitral A waves and shorter transit times. Increased ventricular stiffness may contribute to these changes in cardiac function.
Area of Science:
- Cardiology
- Cardiac Physiology
- Echocardiography
Background:
- A fourth heart sound indicates abnormal ventricular filling.
- The transmitral A wave reflects left atrial contraction and ventricular filling dynamics.
Purpose of the Study:
- To examine the characteristics of the transmitral A wave in individuals with a fourth heart sound.
- To investigate the relationship between the fourth heart sound, transmitral A wave parameters, and ventricular stiffness.
Main Methods:
- Doppler echocardiography and phonocardiography were used.
- 13 patients with a fourth heart sound and 9 controls were studied.
- Transmitral A wave velocity, acceleration, and transit time (A-Ar interval) were analyzed.
Main Results:
- Patients with a fourth heart sound showed significantly higher peak velocity and acceleration of the transmitral A wave.
- The A-Ar interval was significantly shorter in patients with a fourth heart sound.
- The A-Ar interval independently determined transmitral A wave velocity and acceleration.
Conclusions:
- A fourth heart sound is associated with altered transmitral A wave dynamics.
- Increased ventricular stiffness is a likely contributor to these findings.
- These changes may provide insights into diastolic dysfunction.
Abstract:
To investigate the characters of the transmitted transmitral A wave associated with a fourth heart sound, left ventricular inflow, and outflow Doppler echocardiography and phonocardiography were recorded in 13 patients with a fourth heart sound and 9 age-matched control subjects. The Doppler echocardiographic data were compared between both groups and the peak velocity and acceleration rate of the transmitted transmitral A wave were correlated with other parameters. The peak velocity and acceleration rate of the transmitted transmitral A wave were significantly greater, but the A wave transit time from the mitral valve to the left ventricular outflow tract (A-Ar interval) was significantly shorter in patients with a fourth heart sound. There was a significant correlation between the A-Ar interval and the peak velocity (r = -0.54, P = 0.01) or acceleration rate (r = -0.63, P = 0.002) of the transmitted transmitral A wave. The A-Ar interval was shown to be the independent determinant of both the peak velocity and acceleration rate of the transmitted transmitral A wave by stepwise multiple linear regression. In conclusion, the presence of a fourth heart sound was associated with a higher peak velocity and acceleration rate of the transmitted transmitral A wave, to which increased ventricular stiffness may make some contributions.