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Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole
Gabriel W Yip1, Yan Zhang, Peggy Y Tan
1Division of Cardiology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China.
Insights
Diastolic dysfunction is often linked to systolic function, even with normal ejection fraction. Ventricular long-axis motion in early diastole closely relates to systolic performance, suggesting
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- Impaired long-axis motion signifies systolic dysfunction.
- Limited data exist on systolic and diastolic long-axis motion interplay, especially in diastolic dysfunction with normal ejection fraction.
Purpose of the Study:
- To investigate the relationship between systolic and diastolic long-axis motion.
- To assess this relationship in subjects with varying degrees of systolic and diastolic dysfunction, including those with normal ejection fraction.
Main Methods:
- Studied 311 subjects (105 healthy volunteers) using tissue Doppler and M-mode echocardiography.
- Measured mitral annular amplitude and peak velocity in systole and diastole (early and late).
- Analyzed correlations between systolic (S(LAX), S(m)) and diastolic (E(LAX), E(m), A(LAX), A(m)) parameters.
Main Results:
- Systolic long-axis parameters correlated well with early and late diastolic components.
- Non-linear equations provided a better fit than linear models for S(LAX) vs. E(LAX) and S(m) vs. E(m).
- After adjustments, strong linear relationships persisted between diastolic and systolic long-axis measures, even in isolated diastolic dysfunction.
Conclusions:
- Ventricular long-axis motion in early diastole is closely linked to systolic function.
- This association holds true even in the presence of diastolic dysfunction.
- 'Pure' or isolated diastolic dysfunction appears uncommon.
Abstract:
Impaired long-axis motion is a sensitive marker of systolic myocardial dysfunction, but no data are available that relate long-axis changes in systole with those in diastole, particularly in subjects with diastolic dysfunction and a 'normal' left ventricular (LV) ejection fraction. A total of 311 subjects (including 105 normal healthy volunteers) aged 20-89 years with variable degrees of systolic function (LV ejection fraction range 0.15-0.84) and diastolic function were studied using tissue Doppler echocardiography and M-mode echocardiography to determine mean mitral annular amplitude and peak velocity in systole and early and late diastole. The LV systolic mitral annular amplitude (S(LAX), where LAX is long-axis amplitude) and peak velocity (S(m)) correlated well with the respective early diastolic components (E(LAX) and E(m)) and late diastolic (atrial) components (A(LAX) and A(m)). A non-linear equation fitted better than a linear relationship (non-linear model: S(LAX) against E(LAX), r(2)=0.67; S(m) against E(m), r(2)=0.60; S(LAX) against A(LAX) and S(m) against A(m), r(2)=0.42). After adjusting for age, sex and heart rate, linear relationships of early diastolic (E(LAX), r(2)=0.70; E(m), r(2)=0.60) and late diastolic (A(LAX), r(2)=0.61; A(m), r(2)=0.64) long-axis amplitudes and velocities with the respective values for S(LAX) and S(m) were found, even in those subjects with apparently 'isolated' diastolic dysfunction. Long-axis changes in systole or diastole did not correlate with Doppler mitral velocities. We conclude that ventricular long-axis changes in early diastole are closely related to systolic function, even in subjects with diastolic dysfunction. 'Pure' or isolated diastolic dysfunction is uncommon.