P1488Single wave mitral inflow pattern caused by left ventricular diastolic dyssynchrony in patients with heart failure

Abstract

Abstract Background Mitral E and A waves could fuse to form a single wave in tachycardia. Patients with heart failure (HF) occasionally show single wave mitral inflow despite of non-tachycardiac condition. Purpose To investigate mechanisms of single wave mitral inflow in HF patients with sinus rhythm and normal heart rate. Methods A total of 60 HF patients, including 20 single wave (SW), 20 impaired relaxation (IR) and 20 pseudonormalized (PN) mitral inflow patterns were retrospectively enrolled. All the patients were in sinus rhythm under 85 bpm. Patients with bundle branch blocks and first-degree heart block were excluded. We compared basic echo measurements, magnitude of left ventricular (LV) diastolic dyssynchrony, isovolumic relaxation time (IRT) and BNP levels among 3 groups. Diastolic dyssynchrony was determined as standard deviation of interval between aortic valve closure and peak early diastolic wave of longitudinal strain across 16 LV myocardial segments using 2D speckle tracking echocardiography. Results There was no significant difference in heart rate among 3 groups. Patients with SW showed significantly large magnitude of diastolic dyssynchrony (4.1±1.1) compared to those with IR (2.7±0.7) and PN (2.9±0.9ms), respectively. Likewise, IRT of SW (7.1±2.7) was longer than IR (3.2±0.8) and PN (2.4±0.9ms). BNP level in patients with IR (153±111) was significantly lower than those with SW (558±432) and PN (523±263pg/ml). Representative cases Conclusion HF patients with SW could be caused by LV diastolic dyssynchrony and their BNP levels are comparable to those with PN.