112 - The Ascent Component of Mitral Annular Motion Mainly Reflects the Left Ventricular Diastolic Function

Abstract

Background: M-mode interrogation of the mitral annular plane systolic excursion (MAPSE) and tissue Doppler imaging (TDI) of the MA systolic velocity are accepted surrogate measures of left ventricular (LV) systolic function. Since the MA continues to move during diastole and not only determines the MA ascent (MAa) component but also maximal MAPSE; our study intended to investigate the overall contribution of MAa to LV systole and diastole in patients with normal LV systolic function and in sinus rhythm. Methods: A total of 106 echocardiograms were retrospectively evaluated. LV systolic function was assessed using the modified Simpson's rule, MAPSE and MA TDI measures. LV diastolic function was investigated using standard Doppler criteria. Finally, MAa data was measured as shown in Fig. 1. The studied population was divided according to age: Group 1 included 16 patients (24–39 years); Group 2 contained 52 patients (40–55 years) while Group 3 comprised 38 patients (56–89 years). Results: All measured echocardiographic data is shown in Table 1. In our study sample, while there was no difference in terms of MAPSE; MAa was lowest in Group 1. In a multiple regression analysis, MAa correlated best with MAPSE (<0.001), both early and late diastolic MA velocities (<0.001) and mitral valve inflow early to late diastolic flows (<0.001). No correlation was seen with regards to age, LV systolic function by Simpson’s, or MA TDI systolic velocity. Conclusions: In this study, MAa only correlated with Doppler parameters of LV diastolic and with none of the systolic measures of LV function, except maximal MA systolic excursion. The latter association might simply reflect normal atrio-ventricular dependency that exists between LV systole and diastole. Specifically, the final end diastolic MA resting position determines were the next LV cardiac systolic cycle starts. Additional studies are now required to better examine this atrio-ventricular dependence between LV systole and diastole.Table 1Echocardiographic data of the study population.VariablesGroup 1 (n = 16)Group 2 (n = 52)Group 3 (n = 38)ANOVAAge31 ± 548 ± 467 ± 8<0.001LVEF69 ± 568 ± 973 ± 100.034MV E/A ratio1.6 ± 0.81.3 ± 0.51.0 ± 0.6<0.001MA S' velocity10 ± 38 ± 28 ± 30.009MA E' velocity14 ± 59 ± 38 ± 2<0.001MA A' velocity7 ± 28 ± 210 ± 40.004MA E'/A' ratio2.1 ± 0.81.2 ± 0.50.9 ± 0.4<0.001MAPSE1.4 ± 0.21.3 ± 0.21.3 ± 0.30.102MAa0.4 ± 0.10.6 ± 0.20.6 ± 0.20.017 Open table in a new tab