Detection of a Pseudonormal Mitral Inflow Pattern: An Echocardiographic and Tissue Doppler Study

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 20; no. 4; pp. 345 - 356
• Main Authors: Poerner, Tudor C., Goebel, Björn, Unglaub, Petra, Sueselbeck, Tim, Strotmann, Jörg M., Pfleger, Stefan, Borggrefe, Martin, Haase, Karl K.
• Format: Journal Article
• Language: English
• Published: 350 Main Street , Malden , MA 02148 , USA Blackwell Science Inc 01-05-2003
• Subjects: Analysis of Variance; Blood Flow Velocity; diastolic function; Echocardiography, Doppler; Female; Humans; left ventricular filling pressures; Male; Middle Aged; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; pseudonormalization; Time Factors; tissue Doppler imaging; Ventricular Dysfunction, Left - diagnostic imaging
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1046/j.1540-8175.2003.03040.x

Objective: The aim of this study was to assess the ability of several echocardiographic and tissue Doppler imaging (TDI) derived parameters to improve the noninvasive diagnosis of a pseudonormal mitral inflow pattern. Methods: Ninety‐eight consecutive patients with age‐related normal transmitral Doppler profile underwent echocardiography including TDI and measurement of left ventricular end‐diastolic pressure (LVEDP) using fluid‐filled catheters. Peak transmitral velocities were determined at rest (E, A) and during the strain phase of a Valsalva maneuver. The difference in duration between the pulmonary venous retrograde velocity and the transmitral A‐velocity (PVR–A) was calculated from pulsed Doppler recordings. Propagation velocity of the early mitral inflow (VP) was determined by color M‐mode. Early diastolic peak mitral annulus velocities (E′) and the early diastolic transmyocardial velocity gradient of the posterior basal wall (MVG) were obtained by TDI. Results: Fifty‐two patients presented with normal diastolic function (group I: LVEDP
9.5 ± 3 mm Hg
, E/A
1.1 ± 0.19
), while pseudonormalization, defined as LVEDP 15 mm Hg and E/A > 0.9, was found in 46 patients (group II: LVEDP
23 ± 7 mm Hg
, E/A
1.43 ± 0.83
). The coefficient of linear correlation (r) and the area under ROC – curve (AUC) to predict LVEDP values 15 mm Hg were maximal for the index PVR–A (
AUC = 0.92, r = 0.77
), followed by
E/E′ (AUC = 0.80, r = 0.46), MVG (AUC = 0.65, r = 0.33)
and
E/VP (AUC = 0.69, r = 0.30), P < 0.01
, whereas the decrease in E/A ratio during Valsalva maneuver failed to reach significance. Similar results were observed when echocardiographic parameters were used to estimate the left ventricular diastolic pressure before atrial contraction. Conclusions: PVR–A enabled the most accurate estimation of LVEDP. TDI‐derived indices E/E′ and MVG are also reliable alternatives superior to the classical Valsalva maneuver to detect a pseudonormal transmitral Doppler profile. (ECHOCARDIOGRAPHY, Volume 20, May 2003)