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Difference in the diastolic left ventricular wall motion velocities between aortic and mitral regurgitation by pulsed
1Second Department of Internal Medicine, School of Medicine, The University of Tokushima, Japan.
Insights
Diastolic left ventricular (LV) function differs in aortic regurgitation (AR) versus mitral regurgitation (MR). AR impairs long-axis motion, while MR affects both long and short axes, detectable by tissue Doppler imaging.
Area of Science:
- Cardiology
- Echocardiography
- Diastology
Background:
- Chronic aortic regurgitation (AR) and mitral regurgitation (MR) cause left ventricular (LV) volume overload.
- Understanding diastolic LV function differences is crucial for managing these conditions.
Purpose of the Study:
- To compare diastolic LV wall motion velocity between patients with chronic isolated AR and MR.
- To evaluate the utility of pulsed tissue Doppler imaging in assessing diastolic LV function in these patient groups.
Main Methods:
- Pulsed tissue Doppler imaging was used to record subendocardial motion velocity patterns.
- Measurements were taken at the middle site of the LV posterior wall in parasternal short-axis and apical long-axis views.
- 33 patients with AR, 35 with MR, and 34 healthy controls were studied.
Main Results:
- LV dimensions were increased in AR and MR groups compared to controls; AR group showed greater long-axis dimension.
- LV fractional shortening was reduced along the long axis in the AR group.
- Peak early diastolic wall motion velocity (Ew) was lower along the long axis in AR patients and higher in MR patients compared to controls.
Conclusions:
- Early diastolic LV filling involves short-axis expansion but decreased long-axis excursion in AR.
- Early diastolic LV filling involves expansion along both long and short axes in MR.
- Pulsed tissue Doppler imaging effectively evaluates diastolic LV function in patients with volume overload.
Abstract:
We evaluated the difference in the diastolic left ventricular (LV) wall motion velocity between chronic isolated aortic and mitral regurgitation (AR and MR, respectively) by recording subendocardial motion velocity patterns at the middle site of the LV posterior wall in the parasternal (along the short axis) and apical (along the long axis) long-axis views of the left ventricle with pulsed tissue Doppler imaging. We studied 33 patients with AR and 35 with MR, showing moderate to severe regurgitation, and 34 healthy controls (C). The end-diastolic LV dimension along the short axis was greater in the AR and MR groups than in the C group, and that along the long axis was greater in the AR group than in the MR and C groups. There were no significant differences in percent LV fractional shortening along the short axis among the 3 groups, whereas that along the long axis was significantly smaller in the AR group than in the MR and C groups. The peak early diastolic wall motion velocity (Ew) and the time to Ew from the aortic component of the second heart sound (S2 -Ew) along the long axis were significantly lower and longer, respectively, in patients with AR than in the 2 other groups. The Ew and S2 -Ew along both the short and long axes were significantly higher and shorter, respectively, in patients with MR than in the 2 other groups. The peak early diastolic velocity of the transmitral flow correlated positively with Ew along the short axis in all patients with AR and correlated positively with Ews along the long and short axes in all patients with MR. In conclusion, early diastolic LV filling was associated with expansion of the LV wall along the short axis but with decreased excursion along the long axis in patients with AR, whereas that in patients with MR was associated with expansion of the LV wall along both the long and short axes. Pulsed tissue Doppler imaging was useful for evaluation of diastolic LV function along the long and short axes in patients with diastolic LV volume overload.