The Usefulness of Color M-mode Doppler Echocardiographic Indices in the Assessment of Left Ventricular Diastolic Function

Abstract

Background and Objectives:Early color M-mode Doppler flow propagation (Vp) has been used to distinguish pseudonormal from normal diastolic filling patterns. However, the role of other indices, including the late dia- stolic propagation velocity (Ap) and time delay of mitral flow propagation (VpTD and ApTD), is not clear. Subjects and Methods:Doppler echocardiographic examinations were performed in 89 patients (60.6±9.9 ye- ars, male 59.6%), with an ejection fraction ≥40%, who were admitted for diagnostic coronary angiography. The clinical diagnoses on admission were stable angina (41.6%), unstable angina (30.3%), old myocardial infarction (24.7%) and atypical chest pain (3.3%). The diastolic filling patterns, as confirmed by mitral inflow and pulmo- nary venous flow, were compared with the Ap, VpTD and ApTD indices using color M-mode Doppler echo- cardiography. Results:The age, left ventricular ejection fraction, left ventricular end diastolic and end systolic dimensions, the left atrial size, and the E' and A' velocities of the mitral annulus tissue Doppler were signifi- cantly different between patients with normal and abnormal diastolic filling patterns. In patients with normal filling, impaired relaxation and pseudonormalized filling patterns, the VpTD were 63.1±14.9, 85.2±25.5 and 107.8±36.8 ms (p<0.001), the E/Vp were 1.3±0.4, 1.6±0.6 and 3.1±0.7 (p<0.001), and the E/VpTD were 1.2±0.5, 0.7±0.2 and 0.9±0.4 (p<0.001), respectively. The Ap and ApTD showed significant differences between patients with normal and pseudonormalized filling patterns (Ap 58.3±23.5 vs. 36.2±15.1, p=0.000; ApTD 47.1±19.5 vs. 66.7±22.2, p=0.001). The PVa duration, an index that depends on the left ventricular end-diastolic pressure, was the most important independent predictor for ApTD from a multiple regression analysis (R2 =71.4%). Conclusion: The color M-mode Doppler indices, Ap, VpTD and ApTD, are new diagnostic parameters for diastolic dys-