Enhance of Early Diastolic Left Ventricular Mismatch between Wall Motion and Inflow by Preload Augmentation: Assessment by Dual-Doppler Echocardiography

  • Hirotsugu Yamada, The University of Tokushima, Japan
  • Kenya Kusunose, The University of Tokushima, Japan
  • Noriko Tomita, The University of Tokushima, Japan
  • Yoko Tadatsu, The University of Tokushima, Japan
  • Susumu Nishio, Tokushima University Hospital, Japan
  • Mitsuyo Sato, Tokushima University Hospital, Japan
  • Hazuki Hiraoka, Tokushima University Hospital, Japan
  • Masataka Sata, The University of Tokushima, Japan

    • Background: Early diastolic mitral annular motion occurs concomitant with or prior to transmitral flow in healthy subjects, whereas the flow precedes the annular motion in evaluation of end-diastolic pressure (LVEDP). We evaluated the degree of this mismatch using dual Doppler echocardiography and compared with catheter derived invasive indices.
    Methods: Twenty patients who underwent cardiac catheterization were recruited for this study. Transmitral flow and mitral annular velocities were simultaneously recorded by Dual Doppler echocardiographic system (Hitachi EUB-8500). Time interval between the onset of flow and motion (Te’-E) was measured before and after lower body positive pressure (LBPP).
    Results: LVEDP was increased during LBPP while tau did not change. The peak early diastolic inflow velocity and Te’-E increased during LBPP, although the peak mitral annular velocity did not change. The Te’-E correlated well with LVEDP (r=0.78, p<0.01).
    Conclusions: Elevation of LVEDP prolonged the Te’-E, suggesting that it enhanced early diastolic mismatch between mitral inflow and annular motion. The Te’-E is a sensitive index for noninvasive estimation of LVEDP and dual Doppler echocardiography is practical method for measuring this index accurately.