title: Increased volume reduction of late left-atrial emptying for patients with pseudonormal mitral inflow: an analysis for differentiation between normal and pseudonormal mitral inflow.
abstract: This study was designed to define the role of left atrial (LA) wall motion during left ventricular (LV) diastolic phase for patients with pseudonormal mitral inflow. We perform the M-mode of posterior aortic, indicating LA, wall motion, and Doppler echocardiography following cardiac catheterization among 71 patients with a ratio of early (E) to late mitral flow (A) >1. The amplitude of total LA wall motion (TM), early LA rapid emptying (EM), and late LA emptying (AM) during the LV diastolic phase were all derived from M-mode analysis. Study patients were classified into two distinct groups according to the LV end-diastolic pressure (EDP): patients with a LVEDP value < 15 mmHg (n = 36, normal group), and patients with a LVEDP value > or = 15 mmHg (n = 35, pseudonormal group). Values of AM (4.7 +/- 1.2 vs 5.5 +/- 1.2 mm) and AM/TM (0.43 +/- 0.07 vs 0.55 +/- 0.08) for the normal and pseudonormal groups, respectively, were significantly higher for the pseudonormal group, whereas EM (6.6 +/- 1.8 vs 4.8 +/- 1.4 mm), TM (11 +/- 3 vs 10 +/- 2 mm), EM/AM (1.41 +/- 0.46 vs 0.91 +/- 0.28), EM/TM (0.58 +/- 0.10 vs 0.48 +/- 0.07) were significantly higher for the normal group. Among these parameters, AM/TM correlated best with the time constant of LV isovolumic relaxation (r = 0.77, P < 0.001). Using an AM/TM ratio value of >0.5 as an indicator of LV diastolic function abnormality, the sensitivity, specificity, positive predictive values, and negative predictive values for the detection of pseudonormalization were 85%, 94%, 94%, and 87%, respectively. These findings suggest that the increased volume reduction of late LA emptying (AM/TM) during LV diastolic phase assessed by M-mode echocardiography is useful for evaluating pseudonormal mitral inflow.
authors.affiliation: Cardiology Section, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Ming-Jui
authors.initials: MJ
authors.lastname: Hung
authors.forename: Wen-Jin
authors.initials: WJ
authors.lastname: Cherng
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization / Q000379:methods; D002306:Cardiac Volume / Q000502:physiology*; D015331:Cohort Studies; D003971:Diastole / Q000502:physiology; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis*; D015588:Observer Variation; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology