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J Am Coll Cardiol, 2001; 37:278-285
© 2001 by the American College of Cardiology Foundation
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EXPERIMENTAL STUDY

Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler

Sherif F. Nagueh, MD, FACCa, Huabin Sun, MDa, Helen A. Kopelen, RDMSa, Katherine J. Middleton, RCTa and Dirar S. Khoury, PhDa

a Department of Medicine, Cardiology Section, Baylor College of Medicine, Houston, Texas, USA

Manuscript received April 17, 2000; revised manuscript received August 9, 2000, accepted September 14, 2000.

Reprint requests and correspondence: Dr. Sherif F. Nagueh, 6550 Fannin Street, SM-1246, Houston, Texas 77030
sherifn{at}bcm.tmc.edu

OBJECTIVES

Our goal was to identify the hemodynamic determinants of the mitral annulus (MA) diastolic velocities by tissue Doppler.

BACKGROUND

The MA diastolic velocities are promising indexes of left ventricular (LV) diastolic function. However, their hemodynamic determinants have not yet been evaluated.

METHODS

Ten adult mongrel dogs underwent left atrial (LA) and LV pressure measurements by Millar catheters while tissue Doppler was applied to record the MA diastolic velocities at the septal and lateral corners. Conventional transmitral flow was also obtained. Left atrial and LV pressures were modified utilizing fluid administration and caval occlusion, whereas dobutamine and esmolol were used to change LV and LA relaxation. Left ventricular filling pressures were altered during different lusitropic states to evaluate for the possible interaction of preload and LV relaxation on the early diastolic velocity (Ea).

RESULTS

In the majority of dogs, a positive significant relation was observed between Ea and the transmitral pressure gradient (r = 0.57, p = 0.04). The Ea had strong correlations with tau (r = –0.83, p < 0.001), LV –dP/dt (r = 0.8, p < 0.001) and minimal LV pressure (r = –0.76, p < 0.01). However, there was no relation between Ea and the transmitral pressure gradient in experimental stages where tau >50 ms. Furthermore, the late diastolic velocity at both corners of the MA had significant positive relations with LA dP/dt (r = 0.67, p < 0.01) and LA relaxation (r = 0.73, p < 0.01) but an inverse correlation with LV end-diastolic pressure (r = –0.53, p = 0.01).

CONCLUSIONS

Left ventricular relaxation, minimal pressure and preload determine Ea while late diastolic velocity determinants include LA dP/dt, LA relaxation and LV end-diastolic pressure.

Abbreviations and Acronyms
  Aa = late diastolic annular velocity
  Ea = early diastolic annular velocity
  EDP = end-diastolic pressure
  LA = left atrial
  LV = left ventricular
  MA = mitral annulus
  SV = stroke volume
  tau = time constant of LV relaxation
  TD = tissue Doppler




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