title: Reduced atrial emptying after orthotopic heart transplantation masquerading as restrictive transmitral Doppler flow pattern?*.
abstract: BACKGROUND
  An elevated early (E) to late (A) diastolic filling velocities ratio, typically seen in advanced diastolic dysfunction, has also been observed after cardioversion of atrial fibrillation as a consequence of the depressed left atrial (LA) contractility. We hypothesized that the impaired LA contractile function demonstrated after orthotopic cardiac transplantation (OCT) could also lead to this "pseudorestrictive" pattern.
  
  
  METHODS
  E/A ratio related to the tissue Doppler early mitral annular velocity (Ea) as preload-independent index of LV relaxation was evaluated in all consecutive OCT patients between 2005 and 2007.
  
  
  RESULTS
  The study population comprised 48 patients 97 ± 77 months after OCT. Thirty-two patients (67%) had an E/A ratio > 2. LV systolic function and myocardial relaxation assessed by the Ea velocity were similar compared to patients with normal ratio (61 ± 6% vs. 60 ± 12%, P = 0.854 and 15 ± 4 cm/s vs. 14 ± 3 cm/s, r = 0.15, P = 0.323, respectively). On the other hand, the proportion of the recipient and donor LA cuffs as estimated by the recipient/global LA area ratio and the LA emptying fraction significantly correlated with the E/A ratio (r = 0.40, P = 0.005 and r =-0.33, P = 0.022, respectively).
  
  
  CONCLUSIONS
  Our study shows that there is a high prevalence of elevated E/A ratio after standard OCT which seems mainly related to reduced LA contractility. Recognition of this "pseudorestrictive" pattern may avoid misdiagnosis of diastolic dysfunction.
authors.affiliation: Service of Cardiology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. Patrizio.Pascale@chuv.ch
authors.forename: Patrizio
authors.initials: P
authors.lastname: Pascale
authors.forename: Pierre
authors.initials: P
authors.lastname: Monney
authors.forename: Xavier
authors.initials: X
authors.lastname: Jeanrenaud
authors.forename: Nicole
authors.initials: N
authors.lastname: Aebischer
authors.forename: Patrick
authors.initials: P
authors.lastname: Yerly
authors.forename: Pierre
authors.initials: P
authors.lastname: Vogt
authors.forename: Etienne
authors.initials: E
authors.lastname: Pruvot
authors.forename: Jürg
authors.initials: J
authors.lastname: Schläpfer
mesh_terms: D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D016027:Heart Transplantation / Q000009:adverse effects* / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity