Original Articles
Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation*,**,*

https://doi.org/10.1067/mje.2003.52Get rights and content

Abstract

Myocardial velocities in patients with congestive heart failure (CHF) were studied using pulsed wave Doppler tissue imaging. Velocities were recorded at the mitral and tricuspid annulus. Four sites at the mitral annuli were selected corresponding to the septal, lateral, inferior, and anterior walls of the left ventricle from apical 4- and 2-chamber views. A mean value from the above 4 sites was selected to describe the mitral annular velocities. Only one site of the tricuspid annulus was selected, corresponding to the right ventricular free wall. Three different annular velocities were recorded: the peak systolic, and the peak early and late diastolic velocities. A total of 96 patients were compared with 12 age-matched healthy participants. Patients with CHF had significantly decreased mitral and tricuspid systolic velocities compared with healthy participants (4.9 vs 9.3 cm/s, P <.001, for the mitral annulus and 10.4 vs 14.6 cm/s, P <.001, for the tricuspid annulus). The early diastolic velocity was also reduced in patients compared with healthy participants (5.9 vs 10.9 cm/s, P <.001, for the mitral annulus and 8.6 vs 12.9 cm/s, P <.001, for the tricuspid annulus). Patients with CHF had a severely depressed left ventricular ejection fraction (EF) (27%). The correlation the between systolic mitral annular velocity and EF was relatively good (r = 0.59 and P <.001). The patients with CHF were divided into 2 subgroups depending on the presence or absence of significant mitral regurgitation. There was a correlation between EF and the systolic mitral annular velocity both in patients with (r = 0.61, P <.001) and without (r = 0.59, P <.001) significant mitral regurgitation. In conclusion, compared with healthy participants, the mitral and tricuspid annular velocities are significantly decreased in patients with CHF. The correlation between EF and the systolic mitral annular velocity is relatively good irrespective of the presence or absence of significant mitral regurgitation. Measurements of annular velocities constitute a simple and useful method for evaluating patients with CHF. (J Am Soc Echocardiogr 2003;16:240-5.)

Section snippets

Patients studied

We included 125 consecutive patients admitted to the department of cardiology at our institution as a result of CHF of different causes. The CHF was defined as the presence of clinical symptoms and signs of right heart failure, left heart failure, or both at the time of admission. Excluded were 29 patients as a result of rapid atrial fibrillation, significant aortic valve disease, or insufficient echocardiographic quality. Ultimately, 96 patients were analyzed in this study. A total of 12

Results

The basic echocardiographic parameters of patients as compared with healthy participants are shown in Table 1.

. Heart rate and basic echocardiographic parameters in patients with congestive heart failure and healthy participants

Empty CellCHFHPP value
Heart rate (bpm)80 ± 1668 ± 12<.01
Left-atrial dimension (mm)44 ± 634 ± 3<.001
Left-ventricular dimension (mm)59 ± 944 ± 4<.001
Ejection fraction (%)27 ± 865 ± 5<.001
The ratio between transmitral E/A waves1.72 ± 1.20.96 ± 0.41<.001

CHF, Patients with congestive

Discussion

Recording the myocardial velocities during the cardiac cycle is a new way of assessing myocardial contraction and relaxation. DTI records the systolic contraction and diastolic relaxation of the ventricles. Several methods have been proposed to analyze cardiac function, eg, pulsed wave DTI, color M-mode, tissue tracking.8, 9, 20 The methods have been applied to assess myocardial function in different clinical conditions, eg, myocardial infarction, ischemic heart disease.10, 11, 12 Currently,

Conclusion

Both the systolic and diastolic annular velocities are significantly decreased in patients with CHF, compared with healthy participants. The systolic mitral annular velocity correlated relatively well with the LV EF both in patients with and without severe MR. A reduced systolic mitral annular velocity can be used to assess a severely depressed EF. Recording of mitral and tricuspid annular velocities using pulsed wave DTI is simple in patients with CHF.

References (26)

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Supported in part by a grant from the Swedish Heart-Lung Foundation.

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Reprint requests: Mahbubul Alam, MD, Department of Cardiology, Södersjukhuset, S-118 83, Stockholm, Sweden (E-mail: [email protected]).

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0894-7317/2003/$30.00 + 0

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