Assessment Of Left Ventricular Performance By Quantitative Parameters Of Mitral Annulus Motion

Backgrounds and ObjectivesIt has been reported that longitudinal motion was affected earlier than others when the cardiac function was impaired, so it makes sense to investigate mitral annulus motion and to find the cardiac dysfunction in the early stage under different types of left ventricular dysfunction.This study aims to observe quantitative parameters of mitral valve annulus motion in patients of systolic dysfunction,diastolic dysfunction and asymmetric hypertrophic cardiomyopathy and to explore the value of quantitative parameters of mitral annulus motion in evaluating the left ventricular function, where quantitative parameters of mitral annulus motion include M-mode echocardiography (MME) and pulse wave tissue Doppler imaging (TDI) derived from a omnirange M-mode echocardiography (OME) system.Methods20patients with systolic dysfunction (SD group,male16, average age53.40±3.25years),20patients with diastolic dysfunction (DD group, male10, average age57.7±1.21years),30patients with asymmetric hypertrophic cardiomyopathy(HCM group,male20, average age48.60±14.31years), the patients with valvular heart disease and myocardial infarction were excluded.20age and gender matched healthy volunteers as the control group were studied (NC group, male10, average age50.75±2.24years)Systemic echocardiographic examination was performed to acquire parameters including (1) routine index:Left ventricular diameter,wall thickness, left atrial size, Left ventricular ejection fraction (LVEF), trans mitral diastolic inflow velocities (E, A), mitral annular systolic, early and late diastolic velocities (Sa, Ea, Aa);(2) quantitative index of mitral valve annulus motion:①MME index:mitral annulus displacement (MAD), Peak systolic/diastolic velocities of mitral annulus (Vs, Vd), systolic/diastolic acceleration of mitral annulus (As, Ad), Time to peak systolic/diastolic velocity (Ts, Td), Time to peak systolic/diastolic acceleration (Ts-a, Td-a);②TDI index:Peak systolic/diastolic velocities of mitral annulus (Vs’, Vd’), systolic/diastolic acceleration of mitral annulus (As’, Ad’), Time to peak systolic/diastolic velocity (Ts’, Td’), Time to peak systolic/diastolic acceleration (Ts-a’, Td-a’) Results1.LVEF was significantly decreased in SD group (p<0.05). There was no significant difference in LVEF among NC group,DD group and HCM group. Ea in SD group,DD group and HCM group were all lower than NC group (p<0.05), DD group was the highest; E/Ea in SD group,DD group and HCM group were all higher than NC group (p<0.05),SD group was the highest.2. The MVA quantitative parameters derived from MME and TDI revealed that (1) peak systolic velocities of mitral annulus, peak systolic acceleration of mitral annulus and MAD in SD group, DD group and HCM group were all lower than NC group (p<0.05), and time to peak systolic velocity, time to peak systolic acceleration were longer than NC group (p<0.05). Among all the groups, the variation in SD group was the most significance (p<0.05);(2) peak diastolic velocities of mitral annulus, peak diastolic acceleration of mitral annulus in SD group, DD group and HCM group were all lower than NC group (p<0.05), and the variation in SD group was the most significance (p<0.05); time to peak diastolic velocity, time to peak diastolic acceleration were longer than NC group (p<0.05), and the variation in DD group was the most significance (p<0.05)3. Compared with DD group, the decrement of Vs, Vd, As and Ad at septal of the MVA were at greater degree than that at lateral of the MVA in HCM group (p<0.05) Conclusions1. The left ventricular function can be estimated by the parameters of mitral valve annulus derived from MME and TDI.2. Both impaired left ventricular longitudinal systolic function and diastolic function occurred in patients of either systolic dysfunction or diastolic dysfunction. The types of cardiac dysfunction may depend on the difference in systolic or diastolic myocardial impairment.3. In patients of asymmetric hypertrophic cardiomyopathy, septal longitudinal motion was impaired more severely than that at lateral side, which may related to the thickness of regional myocardium.