PMID- 11000588
OWN - NLM
STAT- MEDLINE
DCOM- 20001129
LR  - 20190921
IS  - 0742-2822 (Print)
IS  - 0742-2822 (Linking)
VI  - 17
IP  - 6 Pt 1
DP  - 2000 Aug
TI  - Tissue Doppler imaging: a new technique for assessment of pseudonormalization of 
      the mitral inflow pattern.
PG  - 539-46
AB  - Left ventricular diastolic dysfunction (LVDD) is a frequent cause of heart 
      failure. Doppler echocardiography has become the method of choice for the 
      noninvasive evaluation of LVDD. However, pseudonormalization (PN) of the mitral 
      inflow often presents a diagnostic challenge in clinical practice. In this 
      setting, we sought to define the role of tissue Doppler imaging (TDI) of the 
      septal mitral annulus. Echocardiography was performed in 36 consecutive subjects 
      (age 59 +/- 10 years). Eighteen of these had diagnosed coronary artery disease 
      (CAD) with recent onset of symptoms (within 3 months), 18 had clinical suspicion 
      of CAD, and 15 had symptoms of heart failure (New York Heart Association [NYHA] 
      Class 2.4 +/- 0.5). The mitral inflow profile (E, A, E/A) was measured by pulsed 
      Doppler, and the deceleration time (DT) and the isovolumic relaxation time (IVRT) 
      were calculated. Peak diastolic velocities of the septal mitral annulus (E(T), 
      A(T), E(T)/A(T)) and the time interval from Q in the ECG to the onset of E(T) 
      were derived from pulsed TDI. Left heart catheterization was performed for direct 
      measurement of left ventricular end-diastolic pressure (LVEDP). PN defined by an 
      E/A ratio > 1 and an LVEDP > or = 16 mmHg was found in nine patients. All 
      patients with PN had symptoms of heart failure (NYHA Class 2.8 +/- 0.5). Patients 
      with and without PN did not differ with respect to the E/A ratio (1.29 +/- 0.44 
      vs 1.16 +/- 0.23, P = ns), DT (182 +/- 38 msec vs 205 +/- 42 msec, P = ns), and 
      IVRT (88 +/- 24 msec vs 92 +/- 18 msec, P = ns). In the group with PN, a 
      significant reduction of E(T) (5.6 +/- 1.8 cm/sec vs 8.8 +/- 2. 9 cm/sec, P < 
      0.05) and E(T)/A(T) (0.5 +/- 0.16 vs 0.82 +/- 0.37, P < 0.05) was detected. In 
      the PN group, the Q-E(T) interval was prolonged (404 +/- 48 msec vs 346 +/- 50 
      msec, P < 0.05). Receiver operating characteristic curve analysis for E(T) 
      yielded an area under the curve of 0.78 +/- 0.06 (P = 0.034) for separating 
      patients with versus without PN. When the combination of E(T) < 7 cm/sec and 
      E(T)/A(T) < 1 was used as cutpoint, PN could be identified with a sensitivity of 
      83% and a specificity of 79%. There was no significant relation between LVEDP and 
      either E(T) (r = 0.32, P > 0. 2) or the Q-E(T) interval (r = 0.14, P > 0.5). In 
      conclusion, E(T) and the Q-E(T) interval appear to be useful parameters for 
      assessing LV diastolic dysfunction in symptomatic patients with a pseudonormal 
      mitral inflow pattern and elevated filling pressures.
FAU - Bruch, C
AU  - Bruch C
AD  - Department of Cardiology, University Essen, Hufelandstr. 55, 45122 Essen, 
      Germany. christian.bruch@uni-essen.de
FAU - Schmermund, A
AU  - Schmermund A
FAU - Bartel, T
AU  - Bartel T
FAU - Schaar, J
AU  - Schaar J
FAU - Erbel, R
AU  - Erbel R
LA  - eng
PT  - Clinical Trial
PT  - Comparative Study
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Echocardiography
JT  - Echocardiography (Mount Kisco, N.Y.)
JID - 8511187
SB  - IM
MH  - Aged
MH  - Animals
MH  - Blood Flow Velocity
MH  - Coronary Disease/diagnosis/*diagnostic imaging
MH  - Dogs
MH  - Echocardiography, Doppler, Pulsed/*methods
MH  - Female
MH  - Humans
MH  - Linear Models
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/diagnostic imaging/*physiopathology
MH  - Probability
MH  - ROC Curve
MH  - Statistics, Nonparametric
MH  - Ventricular Dysfunction, Left/diagnosis/*diagnostic imaging
MH  - *Ventricular Pressure
EDAT- 2000/09/23 11:00
MHDA- 2001/02/28 10:01
CRDT- 2000/09/23 11:00
PHST- 2000/09/23 11:00 [pubmed]
PHST- 2001/02/28 10:01 [medline]
PHST- 2000/09/23 11:00 [entrez]
AID - 10.1046/j.1540-8175.2000.00539.x [doi]
PST - ppublish
SO  - Echocardiography. 2000 Aug;17(6 Pt 1):539-46. doi: 
      10.1046/j.1540-8175.2000.00539.x.