The mitral annular middiastolic velocity curve: functional correlates and clinical significance in patients with left ventricular hypertrophy.
BACKGROUND
Little is known regarding the tissue Doppler characteristics and clinical significance of mitral annular motion during diastasis (L' wave).


METHODS
In consecutive patients with left ventricular hypertrophy and normal ejection fraction, standard Doppler and Doppler tissue imaging were performed. Patients were followed up for heart failure (HF) hospitalization.


RESULTS
Of 177 patients, 53 (30%) had an L', detected most frequently at the lateral mitral annulus, whereas 35 (20%) had middiastolic transmitral flow (L wave), which almost invariably coexisted with the L'. The L' predicted increased left ventricular filling pressure with 74% sensitivity and 82% specificity, and increased risk of future HF (hazard ratio 3.9 [P = .030]), even after adjusting for baseline clinical differences (hazard ratio 6.5 [P = .024]). When associated with an L wave, HF risk increased further.


CONCLUSIONS
Middiastolic annular motion, detectable in almost a third of patients with left ventricular hypertrophy, may be an early marker of diastolic dysfunction and a prognostic marker for HF.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Carolyn S P
CS
Lam
Lin
L
Han
Jae K
JK
Oh
Hong
H
Yang
Lieng H
LH
Ling
D000368:Aged; D001783:Blood Flow Velocity; D015331:Cohort Studies; D016001:Confidence Intervals; D003971:Diastole / Q000502:physiology; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016017:Odds Ratio; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology