Additional value of lateral tissue Doppler imaging in the assessment of diastolic dysfunction among subjects with pseudonormal pattern of mitral inflow

Abstract

BackgroundThere has been a lack of research on further stratification of subjects who have pseudonormal pattern of mitral inflow. The study aim was to clarify 2 different groups with different diastolic function grades among these subjects using lateral tissue Doppler imaging (TDI).MethodsA total of 122 consecutive subjects showing pseudonormal pattern of mitral inflow (E/A ≥ 1 and septal e’/a’ < 1) without structural abnormality were prospectively recruited. TDI measurements were performed from both septal and lateral mitral annuli.ResultsStudy subjects were stratified according to lateral TDI pattern (e’/a’ < 1 [n = 50] versus e’/a’ ≥ 1 [n = 72]). Subjects with lateral e’/a’ < 1 had higher values of left atrial volume index (LAVI) and E/e’ compared to those for lateral e’/a’ ≥ 1 (p < 0.001 for each). Among subjects with lateral e’/a’ ≥ 1, only 9.3% of subjects had grade II diastolic dysfunction, whereas among subjects with lateral e’/a’ < 1, majority of subjects (64.1%) had grade II diastolic dysfunction (p < 0.001). Multiple linear regression analysis showed that lateral e’/a’ was independently associated with LAVI (β = −0.484, p < 0.001), even after adjusting for potential confounders including age, sex, body mass index, hypertension and diabetes.ConclusionsIn subjects without structural abnormality showing E/A ≥ 1 and septal e’/a’ < 1, lateral TDI measurement is useful in the assessment of diastolic dysfunction. Lateral e’/a’ ≥ 1 is a valuable indicator of early diastolic dysfunction but not of advanced diastolic dysfunction in this population.

Echocardiographic Evaluation of Left Atrial Mechanics: Function, History, Novel Techniques, Advantages, and Pitfalls

“…Park et al suggested that the lateral E/Ea PW-TDI ratio may be more reflective of true LV diastolic function [ 76 ]. Similar observations were described by Kim et al [ 77 ] using TDI. This working group suggested an overestimation of diastolic dysfunction using septal e′/a′ and proposed a lateral TDI e′/a′ ratio as an indicator of early but not of advanced diastolic dysfunction in subjects with a PW-Doppler mitral inflow ratio of E/A > 1 and a septal TDI ratio of e′/a′ < 1.…”

“…Of all of the proposed parameters, only e′ (E′) and a′ (A′) derived from TDI ( Figure 3(b) ) (earlier from conventional PW-Doppler) [ 41 ] were validated and passed into routine clinical practice. The parameters were used with varying relevance [ 35 , 68 , 77 ] and in different combinations [ 68 ] and were associated with the pitfalls of angle dependency [ 71 , 81 ], reproducibility, and invasive validation [ 68 , 82 ] ( Figure 3(b) ). Hayashi et al [ 81 ] demonstrated angle dependency and lower mitral annulus motion measurement values using TDI.…”

Estimating filling pressures in paediatric heart transplant recipients using echocardiographic parameters and B-type natriuretic peptide

“…Echocardiography has been disappointing, particularly in paediatric heart recipients, in part because no single echocardiographic parameter has had acceptable predictive accuracy for rejection and, in part because the correlation between standard echocardiographic parameters of diastolic function and severity of diastolic dysfunction has not been rigorously validated. [37][38][39][40] Evidence from this study suggests that multiple echocardiographic parameters in conjunction with other noninvasive parameters could provide improved predictive equations for filling pressures. On the other hand, B-type natriuretic peptide levels can be elevated by factors in addition to wall stress.…”

Echocardiographic assessment of myocardial ischemia

“…TDI has provided new insight into the analysis of myocardial mechanics in patients with coronary disease (10,62,66). The clinical utility of the TDI technology has offered new insight into the analysis of LV dyssynchrony (67,68), and among the most frequently used applications are the evaluation of diastolic function (13,69,70) and the appraisal of LV end-diastolic pressure (71) (E/e' ratio) (72). The last issue remains controversial (73).…”