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Characteristics of left ventricular diastolic function in patients with systolic heart failure: a Doppler tissue
Bassem A Samad1, Jens M Olson, Mahbubul Alam
1Department of Cardiology, Karolinska Institute, South Hospital (Södersjukhuset), Stockholm, Sweden. bassem.samad@sodersjukhuset.se
Insights
Doppler tissue imaging reveals reduced mitral annular velocities in patients with heart failure and low ejection fraction. This technique helps identify diastolic dysfunction, particularly in the pseudonormal pattern.
Area of Science:
- Cardiology
- Echocardiography
- Diastology
Background:
- Patients with severely decreased left ventricular (LV) systolic function often exhibit diastolic dysfunction.
- Characterizing diastolic dysfunction is crucial for managing heart failure.
Purpose of the Study:
- To characterize myocardial velocity profiles in different types of diastolic dysfunction.
- To assess diastolic dysfunction in patients with reduced left ventricular (LV) systolic function.
Main Methods:
- Echocardiographic Doppler examination including transmitral inflow and mitral annular Doppler tissue imaging.
- Inclusion of 126 patients with congestive heart failure and LV ejection fraction ≤ 35%.
Main Results:
- Patients showed decreased systolic and early diastolic mitral annular velocities compared to controls.
- Mitral annular velocities were similarly reduced across restrictive, pseudonormal, and abnormal relaxation diastolic patterns.
- The ratio of transmitral early wave to mitral annular early velocity, indicating LV filling pressure, was highest in the restrictive group and elevated in the pseudonormal group.
Conclusions:
- Doppler tissue imaging enhances the estimation of diastolic dysfunction in patients with reduced LV systolic function.
- This imaging modality aids in disclosing abnormal diastolic function, especially in the pseudonormal group.
Objective:
Our aim was to characterize myocardial velocity profiles in different types of diastolic dysfunction for patients with severely decreased left ventricular (LV) systolic function.
Methods:
A total of 126 patients with congestive heart failure and an LV ejection fraction of 35% or less were included. Patients underwent an echocardiographic Doppler examination, with measurement of the transmitral inflow pattern, and Doppler tissue imaging of the mitral annulus.
Results:
Compared with age-matched control subjects, the patients had decreased systolic (9.5 vs 4.9 cm/s, P < .001) and early diastolic (11.6 vs 5.6 cm/s, P < .001) mitral annular velocities. According to the transmitral inflow pattern, 56 patients had signs of a LV restrictive pattern, 36 had a pseudonormalization pattern, and 34 had an abnormal relaxation pattern. The peak systolic and early diastolic mitral annular velocities were quite similarly reduced in different diastolic groups (systolic velocities of 4.6, 5.0, and 5.3 cm/s, and early diastolic velocities of 5.7, 5.8, and 5.1 cm/s at restrictive, pseudonormal, and abnormal relaxation, respectively). The ratio of the transmitral early wave and mitral annular early velocity, an expression of LV filling pressure, was highest in the restrictive group compared with other groups (17.0, 14.6, and 11.7 in the above 3 groups, respectively, P < .001 among groups). The ratio of the transmitral early wave and mitral annular early velocity was also higher in the pseudonormal group than in a control group of patients with ejection fraction of 35% or more with signs of a normal/pseudonormal pattern (14.6 vs 9.0, P < .001).
Conclusion:
Doppler tissue imaging may enhance the estimates of diastolic dysfunction in patients with decreased LV systolic function, and help to disclose abnormal diastolic function especially in a pseudonormal group.
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