Prognostic value of the atrial pulsed Doppler recordings of transmitral flow in the assessment of left ventricular diastolic dysfunction.

Volume sample location is the most important factor influencing pulsed Doppler recordings of left ventricular (LV) diastolic filling. Transmitral diastolic flow velocities measured at the tips of mitral valve leaflets are usually higher than those obtained from atrial location. Nevertheless, independently of volume sample location, differences between early to late velocities ratio (E/A) are nonsignificant, so E/A became the most useful index of ventricular diastolic performance. In some patients, however, with E/A > 1 measured between the tips of mitral leaflets, the pattern of delayed LV relaxation, with diminished E and predominant A wave (E/A < 1), is often obtained from left atrial volume sample location. The aim of our study was to compare LV dimensions and wall thickness between patients with E/A > 1 recorded both at the tips of mitral valve leaflets and in the left atrium and patients with E/A > 1 at the tips of mitral valve leaflets and E/A < 1 in the left atrium. The study population consisted of 51 patients with E/A > 1 recorded between the tips of mitral valve (E/Avent) and excluded pseudonormalized filling pattern. The study population was divided into two groups based on Doppler profile recorded in the left atrium: group A--26 patients with E/A < 1 (E/Aatr) and group B--25 patients with E/Aatr > 1. Patients from group A were significantly older (55.6 +/- 12.8 vs 43.5 +/- 10.5 yrs, p < 0.001) and had increased body mass index (28.8 +/- 4.4 vs 25 +/- 4.1 kg/m2, p < 0.01) compared to subjects from group B. The average thickness of intraventricular septum was 13.5 +/- 2.8 mm in group A and 9.7 +/- 1.6 mm in group B, the average thickness of LV posterior wall was 11.6 +/- 1.7 and 9.2 +/- 1.8 mm, respectively. The results of this study suggest that abnormal atrial recordings of diastolic flows may reflect the earliest stage of left ventricular diastolic dysfunction in asymptomatic patients with echocardiographic signs of mild cardiac damage.