Determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction

The reversal of the early diastolic mitral annular velocity (e') to the late diastolic mitral annular velocity (a') ratio (e'/a' <1) develops earlier in the septum than in the lateral mitral annulus on tissue Doppler imaging (TDI). Accordingly, patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio can be divided into two groups depending on the presence of a reversal of lateral e'/a'. The aim of this study was to identify the determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction.

A total of 1166 consecutive patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' were classified on the basis of their diastolic function at the lateral mitral annulus. Two hundred and fifteen patients had a preserved lateral e'/a' (e'/a' >1) and 915 patients had a reversed lateral e'/a' (e'/a' <1). Patients with lateral e'/a' >1 were younger, male, and had a lower prevalence of diabetes and hypertension and showed less evidence of left ventricular (LV) diastolic dysfunction and structural remodelling as LV hypertrophy and LA enlargement, than those with a lateral e'/a' <1. Multivariate analysis revealed that age, septal e', septal peak systolic annular velocity, and LV mass indexed to height(2.7) (LVM/h(2.7)) were independently associated with preserved diastolic function at the lateral annulus.

The age, septal TDI, and LVM/h(2.7) were independent determinants of preserved diastolic function at the lateral annulus in patients with isolated diastolic dysfunction presenting as a reversed septal e'/a' ratio.