Document Detail

Absence of diastolic mitral annular oscillations is a marker for relaxation-related diastolic dysfunction.
MedLine Citation:
PMID:  17308013     Owner:  NLM     Status:  MEDLINE    
Although Doppler tissue imaging frequently indicates the presence of mitral annular oscillations (MAO) following the E' wave (E'' wave, etc.), only recently was it shown that annular "ringing" follows the rules of damped harmonic oscillatory motion. Oscillatory model-based analysis of E' and E'' waves provides longitudinal left ventricular (LV) stiffness (k'), relaxation/viscoelasticity (c'), and stored elastic strain (x(o)') parameters. We tested the hypothesis that presence (MAO(+)) vs. absence (MAO(-)) of diastolic MAO is an index of superior LV relaxation by analyzing simultaneous echocardiographic-hemodynamic data from 35 MAO(+) and 20 MAO(-) normal ejection fraction (EF) subjects undergoing cardiac catheterization. Echocardiographic annular motion and transmitral flow data were analyzed with a previously validated kinematic model of filling. Invasive and noninvasive diastolic function (DF) indexes differentiated between MAO(+) and MAO(-) groups. Specifically, the MAO(+) group had a shorter time constant of isovolumic relaxation [tau; 51 (SD 13) vs. 67 (SD 27) ms; P<0.01] and isovolumic relaxation time [63 (SD 16) vs. 82 (SD 17) ms; P<0.001] and greater ratio of peak E-wave to peak A-wave velocity [1.19 (SD 0.31) vs. 0.97 (SD 0.31); P<0.05]. The MAO(+) group had greater peak lateral mitral annulus velocity [E'; 17.5 (SD 3.1) vs. 13.5 (SD 3.8) cm/s; P<0.001] and LVEF [71.2 (SD 7.5)% vs. 65.4 (SD 9.1)%; P<0.05] and lower heart rate [65 (SD 9) vs. 74 (SD 9) beats/min, P<0.001]. Additional conventional and kinematic modeling-derived indexes were highly concordant with these findings. We conclude that absence of early diastolic MAO is an easily discernible marker for relaxation-related diastolic dysfunction. Quantitation of MAO via stiffness and relaxation/viscoelasticity parameters facilitates quantitative assessment of regional (i.e., longitudinal) DF and may improve diagnosis of diastolic dysfunction.
Matt M Riordan; Sándor J Kovács
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2007-02-16
Journal Detail:
Title:  American journal of physiology. Heart and circulatory physiology     Volume:  292     ISSN:  0363-6135     ISO Abbreviation:  Am. J. Physiol. Heart Circ. Physiol.     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-06-12     Completed Date:  2007-08-02     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100901228     Medline TA:  Am J Physiol Heart Circ Physiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  H2952-8     Citation Subset:  IM    
Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University, St. Louis, Missouri, USA.
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MeSH Terms
Coronary Artery Disease / complications,  physiopathology,  ultrasonography
Coronary Circulation*
Echocardiography, Doppler / methods*
Image Interpretation, Computer-Assisted*
Middle Aged
Mitral Valve / physiopathology,  ultrasonography*
Models, Cardiovascular
Observer Variation
ROC Curve
Reproducibility of Results
Stress, Mechanical
Stroke Volume
Ventricular Dysfunction, Left / etiology,  physiopathology,  ultrasonography*
Ventricular Function, Left*
Grant Support

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