Evaluate The Doppler Tissue Imaging In Assessing The Global Left Ventricular Diastolic Function

Objective Our purpose was to evaluate the Doppler tissue imaging in assessing the global left ventricular diastolic function by measuring the diastolic mitral annulus motion velocities and to determine the unique benefits by comparing with the pulmonary venous flow and transmitral flow methods. Methods Fifty-seven patients (excluding atrial fibrillation, complete bundle branch block, mitral stenosis, aortic valvular stenosis, moderate or severe mitral regurgitation, moderate or severe aortic valvualr regurgitation and congenital heart diseases with various stages of diastolic dysfunction of various kinds of heart diseases were assigned to delayed relaxation pattern group(n=16), pseudonormal group(n=27), restrictive group(n=14)and twenty-two healthy volunteers matched with age and gender were selected as the control group. The standard parameters of transmitral flow and pulmonary venous flow, and the diastolic mitral annulus motion velocities in different sites (lateral, septal, inferior and anterior) of the long axis from the apical 2-and 4-chamber views were measured and their values were averaged. Ftest (analysis of variance) and Spearman rank correlation were used to analyse the parameters with SPSS software. Results Early diastolic mitral annular velocity (Em) was much lower in patients with delayed relaxation pattern (n=16,Em=8.7 ± 2. 1cm/s), pseudonormal filling pattern (n = 27, Em = 8. 5±2. 4cm/s), or restrictive filling pattern (n=14, Em=8.6±2. 1cm/s), than that in normal control group subjects (n=22, Em=15. 6±3. 9cm, F=34. 41,29. 65 and 41.35, respectively, all p<0. 01). Parameters including E, A, S, D, E/A and S/D mearsured by transmitral flow and pulmonary venous flow changed in a typical parabolic pattern during the diastolic dysfunction progression from normal to severe diastolic dysfunction, ie, the same parameter can be detected in different stages of diastolic dysfunction, in another word, a certain parameter measured bystandard flow Doppler echocardiography was not unique to determine the actual stage of diastolic dysfunction. On the other hand, the velocities measured from the mitral annulus by Doppler tissue imaging decreased steadily in a unimodal type which suggested high value not only in determining the actual stage of diastolic dysfunction but also in differenciating the pseudonormal patterns showed in the flow Doppler patterns. Meanwhile, our study indicated that there was no significant difference of Em between the pseudonormal group and the restrictive group ( F=1.97,p>0.05 ) .Conclusion Mitral annulus diastolic motion velocities assessed by Doppler tissue imaging are useful in diagnosising the global left ventricular diastolic dysfunction precisely, especially in differentiating the normal diastolic function from the pseudonormal left ventricular filling pattern showed in the Doppler flow patterns. On the other hand, the left ventricular preload might affected the Em in some degree.( Cardiovasology ) Sun Zhaojia Directed by - Professor Chen Zuoyuan...