Mitral Annular Systolic Velocity: Clinical Determinants and Relationship to Diastolic Function in Population-based Subjects

Abstract

Background: Systolic mitral annular velocity (Sm), a marker of longitudinal left ventricular (LV) systolic function, has been shown to be reduced in subjects with LV diastolic dysfunction (DD) despite “normal” LV ejection fraction (EF). However, there are limited data to evaluate the clinical determinants of Sm and independent effects of DD on Sm in unselected populations. Aim: To assess the clinical and echocardiographic determinants of Sm in a population-based sample of older adults. Methods: A total of 463 participants of a longitudinal cohort study (mean age 75.5 ± 5.9 years, 52% men) were examined by echocardiography. Sm at the lateral (Smlat) and septal (Smsep) annulus was assessed by pulse-wave tissue Doppler imaging. Results: Smlat was higher than Smsep (0.074 m/s vs. 0.064 m/s, p < 0.001) with a modest correlation between sites (ρ = 0.5; p < 0.001). Smlat was higher in men (0.077 m/s vs. 0.071 m/s; p = 0.005) and lower in those with a history of myocardial infarction and atrial fibrillation (p = 0.003 for both). Sm had a modest correlation with markers of DD (for Smlat: e’: ρ = 0.34; p < 0.001; E/e’: ρ = −0.41;p < 0.001) and was reduced according to DD severity (Table). There was only weak correlation with EF (ρ = 0.14; p = 0.003); LV mass index (ρ = −0.20; p < 0.001); age (ρ = −0.13; p = 0.006); heart rate (ρ = 0.11; p = 0.015); and systolic blood pressure (ρ = −0.15; p < 0.001). In multivariable analysis, DD remained a strong independent predictor of Sm (p < 0.001). Conclusions: In an unselected population of older adults, the relationship between Sm and DD is independent of the effects of other echo-clinical factors. Sm is reduced according to the severity of DD. Normal, n = 155