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Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy
Insights
Dilated cardiomyopathy (DC) patients with mitral regurgitation (MR) showed normal left ventricular (LV) filling. However, DC patients without MR exhibited abnormal LV diastolic filling, suggesting MR masks these abnormalities.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Physiology
Background:
- Dilated cardiomyopathy (DC) is associated with abnormal left ventricular (LV) diastolic function.
- Assessing LV diastolic filling characteristics is crucial for understanding DC progression.
Purpose of the Study:
- To evaluate LV diastolic filling patterns in DC patients with and without mitral regurgitation (MR).
- To determine if MR influences the detection of diastolic abnormalities in DC.
Main Methods:
- Pulsed Doppler echocardiography was used to measure mitral flow velocity parameters.
- Key parameters included peak early diastolic flow velocity (PFVE), peak atrial systolic flow velocity (PFVA), PFVA/PFVE ratio, and deceleration half-time.
- Patients were categorized into DC with MR, DC without MR, and normal controls.
Main Results:
- DC patients with MR showed no significant differences in PFVE, PFVA, or PFVA/PFVE compared to normal subjects, but had a shorter deceleration half-time.
- DC patients without MR exhibited significantly lower PFVE and higher PFVA/PFVE ratios compared to both normal subjects and DC patients with MR.
- PFVA and deceleration half-time were not significantly different in DC patients without MR compared to normal subjects.
Conclusions:
- Abnormalities in LV diastolic filling are present in DC patients without MR.
- Mitral regurgitation appears to mask the underlying left ventricular filling abnormalities in patients with dilated cardiomyopathy.
Abstract:
Patients with dilated cardiomyopathy (DC) have been reported to have abnormal left ventricular (LV) diastolic properties. To evaluate LV diastolic filling characteristics in patients with DC, pulsed Doppler echocardiography was used to study mitral flow velocity in 21 patients with DC and mitral regurgitation (MR), 12 patients with DC but no MR and 19 age-matched normal subjects. Diagnosis of MR was based on the Doppler echocardiographic finding of holosystolic turbulent flow in the left atrium. Peak mitral flow velocity in early diastole (PFVE) and during atrial systole (PFVA), PFVA/PFVE and deceleration half-time of early diastolic flow were measured from Doppler mitral flow velocity recordings. In 21 patients with DC and MR, PFVE (61 +/- 13 cm/s), PFVA (37 +/- 19 cm/s) and PFVA/PFVE (0.6 +/- 0.4) were not significantly different from PFVE (53 +/- 10 cm/s), PFVA (47 +/- 12 cm/s) and PFVA/PFVE (1.0 +/- 0.4) in normal subjects (p greater than 0.05). Deceleration half-time in DC patients with MR (62 +/- 32 ms) was shorter than normal (87 +/- 25 ms) (p less than 0.05). In contrast, PFVE (31 +/- 11 cm/s) was lower and PFVA/PFVE (1.7 +/- 0.8) was higher in the 12 DC patients without MR than in normal subjects and DC patients with MR (p less than 0.005). PFVA (46 +/- 8 cm/s) and deceleration half-time (88 +/- 33 ms) in patients without MR were not significantly different from normal mean values. Thus, abnormalities of peak diastolic mitral flow velocity were detected in DC patients without MR but not in DC patients with MR, suggesting that MR masks LV filling abnormalities in patients with DC.