title: Detection of a pseudonormal mitral inflow pattern: an echocardiographic and tissue Doppler study.
abstract: 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: LVEDP9.5 +/- 3 mm Hg, E/A1.1 +/- 0.19), while pseudonormalization, defined as LVEDP 15 mm Hg and E/A > 0.9, was found in 46 patients (group II: LVEDP23 +/- 7 mm Hg, E/A1.43 +/- 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 byE/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.
authors.affiliation: First Department of Medicine, University Hospital of Mannheim, Mannheim, Germany.
authors.forename: Tudor C
authors.initials: TC
authors.lastname: Poerner
authors.forename: Björn
authors.initials: B
authors.lastname: Goebel
authors.forename: Petra
authors.initials: P
authors.lastname: Unglaub
authors.forename: Tim
authors.initials: T
authors.lastname: Sueselbeck
authors.forename: Jörg M
authors.initials: JM
authors.lastname: Strotmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Pfleger
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Karl K
authors.initials: KK
authors.lastname: Haase
mesh_terms: D000704:Analysis of Variance; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging