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CLINICAL RESEARCH

Diastolic mitral annular velocityduring the development of heart failure

^* Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

Manuscript received November 4, 2002; revised manuscript received January 14, 2003, accepted January 24, 2003.

^* Reprint requests and correspondence: Dr. William C. Little, Cardiology Section, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157-1045, USA.
wlittle{at}wfubmc.edu

OBJECTIVES: We sought to investigate the mechanism of reduced diastolic mitral annular velocity with diastolic dysfunction, despite elevated left atrial (LA) pressure.

BACKGROUND: The peak rate of left ventricular (LV) early diastolic filling (E) and velocity of the mitral annulus due to long-axis lengthening (E_M) are reduced in mild diastolic dysfunction. With more severe dysfunction, E increases in response to increased LA pressures. In contrast, E_M decreases, despite increased LA pressure.

METHODS: We studied eight dogs instrumented to measure LA pressure, LV pressure, and internal dimensions during the progressive development of heart failure (HF) produced by rapid pacing.

RESULTS: Early diastolic filling decreased after four days of pacing from 114 ± 32 to 88 ± 22 ml/s (p < 0.05), but with more severe HF, it progressively increased to 155 ± 32 ml/s (p < 0.05). In contrast, E_M progressively decreased from 44 ± 12 mm/s during the control period to 24 ± 8 mm/s after four weeks (p < 0.05). Although E_M was related to the time constant of LV relaxation (tau) (R² = 0.85), E was not. The latter occurred coincident with termination of the early diastolic LA to LV pressure gradient during all conditions. In contrast, with increasing HF, E_M was progressively delayed after LA to LV pressure crossover by 37 ± 12 ms (p < 0.05). The time from E to E_M was related to tau (R² = 0.97).

CONCLUSIONS: With slowed relaxation during the development of HF, E_M is reduced and delayed so that it occurs after early, rapid filling. Thus, with slowed relaxation, E_M does not respond to the early diastolic LA to LV pressure gradient, because it occurs when LV pressure is greater than or equal to LA pressure.

Abbreviations and Acronyms   DAP = anteroposterior dimension   DLA = long-axis dimension   DSL = septolateral dimension   dV/dt = time derivative of left ventricular volume   E = peak early diastolic left ventricular filling   EM = peak velocity of mitral annulus away from apex during early diastole   HF = heart failure   LA = left atrial/atrium   LV = left ventricle/ventricular   tau = time constant

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