Assessment of systolic function by atrioventricular plane displacement in patients with diastolic dysfunction

Early recognition and appropriate therapy of diastolic dysfunction (DD) is advisable to prevent further progression to diastolic or systolic heart failure and death. The mitral atrioventricular plane displacement (AVPD) method has been shown to be a reliable and simple technique to study left ventricular systolic function in patients, because the mitral annulus can be visualized in almost all patients even if the endocardial borders are difficult to trace. The aim of our study is to estimate the left ventricular ejection fraction by AVPD method (EFAVPD), in addition to Teicholz's short axis method (EF-T) and Simpson's biplane method (EF-2D) in patients with DD.

One hundred and two subjects were submitted to complete echocardiographic assessment, and DD was shown in 62 patients. The systolic mitral AVPD was recorded at 4 sites (septal, lateral, anterior, and posterior) using M-mode and left ventricular ejection fraction was calculated from the AVPD-mean in 62 patients with DD (mean age 55.67 +/- 5.65, 24 men and 38 women) and in 40 age-matched control subjects (mean age 54.07 +/- 6.96, 15 men and 25 women). There were no statistically significant group differences related to age, gender, heart rate or body mass index. However, in the patients with DD, presence of hypertension and/or diabetes mellitus was significantly higher than control subjects.

The systolic functions, as assessed by conventional measures in patients with DD and healthy subjects were not stastically different, and were within normal limits. The septal, anterior, lateral and posterior part of the atrioventricular plane values and AVPD-mean during systole were statistically lower in the DD group (12.35 +/- 1.42 mm) compared with controls (15.32 +/- 1.38 mm) (p < 0.001). EFAVPD in patients with DD was statistically lower (62.97 +/- 7.85%) than healthy subjects (79.30 +/- 7.60%) (p < 0.001). Significant positive correlations between EFAVPD and EF-2D (r = 0.325, p < 0.01) and EF-T (r = 0.355, p < 0.01) and FS (r = 0.314, p < 0.01) were found. EFAVPD correlated only with velocity of mitral flow propagation (VPR) in diastolic function parameters (r = 0.374, p < 0.01).

The AVPD method may indicate a systolic dysfunction with a relatively lower AVPD-mean and relatively lower EFAVPD in the DD group compared with controls. This indicated the presence of a statistically significant and mildly reduced left ventricular systolic function by the AVPD method in patients with DD. It might be suggested that DD might be combined with systolic dysfunction. However, isolated diastolic dysfunction is uncommon. The mitral AVPD is reproducible, widely applicable and a simple non-invasive method for the estimation of left ventricular systolic function in patients with DD.