Peak Early Diastolic Annular Velocity Research Articles

Effects of pemafibrate on left ventricular diastolic function in patients with type 2 diabetes mellitus: a pilot study.

Diabetic cardiomyopathy (DCM) is characterized predominantly by diastolic dysfunction. The multiple mechanisms underlying DCM include altered energy substrate utilization. Recent studies indicate that PPARα plays an important role in the pathogenesis of lipotoxic cardiomyopathy. Pemafibrate is known to be a selective PPARα modulator (SPPARMα). We thus investigated the effects of pemafibrate on cardiac diastolic function in patients with type 2 diabetes. Seventeen patients with type 2 diabetes (T2D) and hypertriglyceridemia were screened and treated with pemafibrate at a dose of 0.2mg/day for 8-16weeks. Fourteen patients were eligible for analysis. Echocardiography was used for assessment of diastolic function. Early diastolic filling velocity (E), late atrial filling velocity (A) and the E/A ratio were included in this study. Peak early diastolic annular velocities (e') were also assessed using color tissue Doppler images. The primary endpoints were changes in the ratio of E to A (E/A), e', and the ratio of E to e' (E/e') from baseline. Pemafibrate significantly increased average e' (7.24 ± 0.58 vs 7.94 ± 0.67, p = 0.019) and a significant reduction in E/e' (9.01 ± 0.94 vs 8.20 ± 0.91, p = 0.041). The increase in e' was significantly related to increases in fasting blood glucose (r = 0.607, p = 0.021) and non-esterified fatty acid (r = 0.592, p = 0.026). Pemafibrate improved diastolic function in patients with T2D and hypertriglyceridemia, suggesting that PPARα activation by pemafibrate prevents the development of DCM at an early stage.

Effects of liraglutide on diastolic function parameters in patients with type 2 diabetes and coronary artery disease: a randomized crossover study

BackgroundDiastolic dysfunction is highly prevalent in patients with type 2 diabetes mellitus (T2DM) and is associated with overweight, glucose dysregulation and coronary artery disease (CAD). The GLP-1 receptor agonist, liraglutide, has shown to induce weight loss and improve metabolic factors, thus modulating factors associated with diastolic dysfunction. We have previously reported the effects of liraglutide on systolic function, and in this current study we explore the effects of liraglutide on diastolic function parameters in patients with stable CAD, preserved left ventricular ejection fraction (LVEF), and newly diagnosed T2DM.MethodsThirty subjects were randomized to liraglutide or placebo intervention for 12 + 12-weeks in this double-blind cross-over study. 2D-echocardiography using tissue velocity imaging was used for assessment of diastolic function parameters. Early diastolic filling velocity (E), late atrial filling velocity (A), E-wave deceleration time (EDT) and E/A ratio was assessed from the pulse wave (PW)-Doppler velocity recording of the mitral inflow. Peak early diastolic annular velocities (e′) was measured from color tissue doppler images.ResultsLiraglutide, when compared to placebo, induced a significant reduction in average e′ and lateral e′ velocities (– 0.57 cm/s [– 1.05 to − 0.08] and –0.74 cm/s [–1.32 to –0.15], respectively). Adjusted for the concomitant increase in HR (+ 6.16 bpm [0.79 to 11.54], the changes were not significant. No significant changes in other diastolic function parameters were observed.ConclusionsLiraglutide therapy did not improve any diastolic function parameters in subjects with T2DM, CAD, and preserved LVEF. Instead, a deterioration in e’ was observed, which was associated to an increase in heart rate induced by liraglutide therapy.Trial registration Clinical Trial Registration: http://www.clinicaltrials.gov (unique identifier: NCT01595789) (first submitted May 8, 2012)

A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy

Abstract Background Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility. Purpose Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function. Methods We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity Results Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1). Conclusion Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO. Funding Acknowledgement Type of funding source: None

P278 Does recanalization of chronic total occlusion reflect on myocardial function?

Abstract Background Percutaneous coronary intervention for chronic total occlusion (PCI CTO) is still high risk procedure and it is doubtful will it become standard of care. There is evidence that it can reduce angina but even silent ischemia represent ischemic burden that ultimately lead to left ventricle remodeling and electrical instability. Purpose Our aim was to access effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) on myocardial function. Methods We compared two groups of pts. First patients with percutaneous coronary intervention of chronic total occlusion with optimal medical therapy and second group - patients with only optimal medical therapy (control group). Echocardiographic exam was performed before randomization and after 6 months of follow-up. Doppler intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured. MPI (Myocardial performance index) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral wave (E) was divided by average peak early diastolic annular velocity (e"). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time intervals from 17 segments, reflecting myocardial contraction heterogeneity. Results A total of 94 age matched CTO patients (48 in PCI + OMT group and 46 in OMT) were analyzed. Changes in ejection fraction (EF), diastolic function represented by E/e", global cardiac function represented by MPI, global longitudinal strain (GLS) and myocardial dispersion changes were compared between groups. At follow up between groups in there was no significant change in ejection fraction (EF), diastolic function, GLS and mechanical dispersion, but there was improvement in MPI. Conclusion Myocardial performance index is sensitive marker which can detect subtle improvement in global myocardial function after recanalization of chronic total occlusion.. Variable PCI + OMT (n = 46) OMT (n = 48) ΔOMT vs. ΔPCI + OMT p value baseline At 6month follow up P value baseline At 6month follow up P value EF (%) 55.69 ± 8.56 54.83 ± 8.44 0.10 50.22 ± 11.71 51.42 ± 10.45 0.06 0.71 MPI 0.676 ± 0.99 0.632 ± 0.96 <0.01* 0.593 ± 0.14 0.604 ± 0.12 0.22 <0.01* E/e" 13.10 ± 6.90 12.05 ± 5,08 <0.05* 14,12 ± 5.70 13.02 ± 5.62 <0.05* 0.23 GLS (%) -14,38 ± 3,38 -15,22 ± 3,68 <0.05* -13.33 ± 3.43 -13.29 ± 3.42 0.87 0.07 Mechanical dispersion (ms) 63.89 ± 26.22 57.35 ± 27.33 <0.01* 53.30 ± 21.68 50.00 ± 22.40 0.05 0.06 Δ- percentage changes between baseline and at 6 month follow up

P284 Patients with reduced systolic function benefit most from recanalisation of chronic total occlusion

Abstract Background Percutaneous coronary intervention of chronic total coronary occlusion (PCI of CTO) is proved to reduce symptoms of angina and long term survival. Purpose This study aimed to assess systolic and diastolic left ventricular function with standard echocardiographic indices. Methods We analyzed total of 46 CTO patients (age 58 ± 9, 73% male). Measures were obtained with the transducer in the apical four-chamber view. Doppler time intervals were measured from mitral inflow and left ventricular outflow Doppler tracings by pulsed wave Doppler. The isovolumetric relaxation time (IVRT) was measured from closure of the aortic valve to opening of the mitral valve. The isovolumetric contraction time (IVCT) was measured from closure of the mitral valve to opening of the aortic valve. Ejection time (ET) was measured from the opening to the closure of the aortic valve on the LV outflow velocity profile. Myocardial performance index (MPI) is simple method for evaluation of overall cardiac function and is independent of heart rate and blood pressure. MPI was equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e") which was measured as average value between septal and lateral side of the mitral annulus using Doppler tissue imaging. The E/e’ ratio was calculated to estimate the LV filling pressures Results Six months after PCI of CTO patients showed no change in ejection fraction (EF) (55.69 ± 8.56% vs. 54.83 ± 8.44%, p = 0.10). MPI was significantly decreased (0.676 ± 0.99 vs. 0.632 ± 0.96 p < 0.01), E/e" was significantly reduced, (13,10 ± 6.90 vs. 12.05 ± 5.1 p < 0.05), and when we analyzed only patients with baseline EF < 50% (n = 9) improvement of diastolic function (reduction of E/e") was even greater (22.53 ± 5.52 vs. 15.65 ± 4.8 p < 0.01). Conclusion PCI of CTO improves overall cardiac function, particularly diastolic function in patients with reduced ejection fraction.

Echocardiographic findings in children with chronic kidney disease.

Cardiovascular diseases (CVD) are considered major cause of morbidity and mortality among children with chronic kidney disease (CKD). This study aims to determine the incidence of CVD in children with CKD, to analyze risk factors and early predictors for late onset atherosclerosis. Thirty-five CKD children [25 on regular hemodialysis (HD) and 10 on conservative management] were evaluated clinically. Left ventricular (LV) functions and carotid artery intima-media thickness (c-IMT) were assessed using conventional echocardiography, pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI). There was decreased E/A ratio and increased E/E' ratio in 66% and 77% of patients, respectively signifying diastolic cardiac dysfunction. There was a significant correlation between increased A' value (peak late diastolic annular velocity) and both increased serum cholesterol and anemia (P = 0.009, 0.004 respectively). Serum high density lipoprotein (HDL) significantly correlated negatively with inter-ventricular septal thickness and LV end-diastolic dimensions (P = 0.05, 0.02, respectively) and positively with E' value (peak early diastolic annular velocity) (P = 0.04). Abnormal c-IMT correlated significantly with HD duration (correlation coefficient = 0.428, P = 0.01) and with both increased serum cholesterol and decreased serum HDL (P = 0.021, 0.031, respectively). Diastolic dysfunction and abnormal LV dimensions are present in patients with CKD even those on conservative management. TDI appears to be more impressive than PWD in assessing early myocardial dysfunction. Increased c-IMT and dyslipidemia are prevalent in patients with CKD and more prevalent in patients on HD.

Pegylated Interferon-α Plus Ribavirin Therapy Improves Left Ventricular Diastolic Dysfunction in Patients With Chronic Hepatitis C Attaining Sustained Virological Response

BackgroundPegylated interferon (pegIFN) in combination with ribavirin (RBV) has successfully improved the rate of sustained virological response (SVR) in chronic hepatitis C virus (HCV) infected individuals, which reduces the progression of the chronic liver disease. However, the influence of combination therapy (pegIFN/RBV) on cardiac function has yielded ambiguous results. The present study aimed to evaluate the effects of combination therapy with pegIFN/RBV on cardiac function of HCV-infected individuals with SVR. Materials and MethodsCardiac function was assessed and correlated in 142 treatment-naïve patients with HCV infections by determining cardiac biomarkers and echocardiography before treatment and for 24 weeks post-treatment. ResultsAn SVR was achieved by 50.7% of all patients. Serum N-terminal pro-B-type natriuretic peptide levels were significantly higher in all patients before treatment and decreased significantly 24 weeks post-treatment in the SVR group (62.84 [36.98-102.73] versus 22.87 [15.64-56.92] pg/mL, P < 0.01). Peak early diastolic annular velocity (E′) was significantly lower (7.69 ± 2.48 versus 9.74 ± 2.68cm/s, P < 0.001) and E/E′ was higher (10.04 ± 2.51 versus 8.18 ± 2.31, P < 0.001) in all patients with SVR. However, there were no statistically significant differences in biomarkers and echocardiographic parameters for patients without SVR. In addition, multivariate analysis identified age (odds ratio [OR] = 1.076; 95% CI: 1.031-1.125; P < 0.001), NT-proBNP (OR = 1.122; 95% CI: 1.002-1.248; P = 0.015), and SVR (OR = 0.532; 95% CI: 0.214-0.895; P = 0.023) as statistically significant independent variables associated with left ventricular diastolic dysfunction. ConclusionsThe present study showed no adverse effects of combination therapy on cardiac function of HCV-infected individuals with SVR. Subsequent viral eradication resulted in improvement of left ventricular diastolic dysfunction.

Non Invasive Assessment of Left Ventricular Filling Pressure and Remodeling after Acute Myocardial Infarction

Left ventricular (LV) dilation after acute myocardial infarction (AMI) is an important determinant of prognosis. The ratio of early mitral inflow velocity (E) and peak early diastolic annular velocity (e') provides the best single index for noninvasive detection of acute elevation of LV filling pressure. To assess whether E/e' ratio predicts LV remodeling after properly treated AMI compared with traditional clinical, laboratory and echocardiographic data. Comprehensive echocardiograms were performed in a series of consecutive patients with first AMI successfully treated with primary percutaneous transluminal angioplasty (PTCA), both 48 hours after intervention and 60 days later. Mean E/e' was determined from four sites of the mitral annulus. LV remodeling was defined as more than 15% increase in end-systolic volume estimated by Simpson method. Statistical analysis included Student's t test, receiver-operator curves (ROC) and multivariate logistic regression (all significant with p < 0.05). Fifty-five patients were included, with mean age 58 ± 11 years, 43 men. The group of patients who underwent LV remodeling (n = 13) had higher baseline E/e' than those without (13 ± 4 versus 8.5 ± 2, p < 0.001). The ROC curve showed E/e' > 15 as a predictor of remodeling (AUC = 0.81, p = 0.001). In addition, regression analysis (comprising clinical, laboratory and echocardiographic variables along with AMI site) confirmed the independent value of E/e' in the prediction of LV remodeling (odds ratio 1.42, p = 0.01). The E/e' ratio is a useful predictor of LV remodeling after AMI, indicating patients with increased cardiovascular risk.

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

Although B-type natriuretic peptide (BNP) is widely used as a biomarker for heart failure, the in vivo mechanical stimulus for its cardiac release remains poorly defined. We aimed to characterize the hemodynamic determinants of the transcardiac BNP gradient as a measure of myocardial BNP release by performing a detailed hemodynamic assessment in subjects with a broad spectrum of systolic and diastolic left ventricular dysfunction. Forty-two subjects underwent a detailed transthoracic echocardiographic study, right heart catheterization, and simultaneous BNP measurement in arterial and coronary sinus plasma. The transcardiac BNP gradient was lowest in subjects with normal left ventricular ejection fraction/high peak early diastolic annular velocity (n=11), intermediate in those with normal left ventricular ejection fraction/low peak early diastolic annular velocity (n=13), and highest in those with low left ventricular ejection fraction/low peak early diastolic annular velocity (n=18; 29 ng/L (range: 15 to 78 ng/L) versus 88 ng/L (range: 34 to 172 ng/L) versus 1566 ng/L (range: 624 to 2349 ng/L; P<0.001). Across the range of patients, left ventricular end-systolic wall stress (r(2)=0.51) and peak systolic mitral annular velocity (r(2)=0.47) showed the strongest correlation with higher transcardiac BNP gradient. In contrast, the transcardiac BNP gradient was weakly related to indices of diastolic load, including pulmonary capillary wedge pressure (r(2)=0.27) and left ventricular end-diastolic wall stress (r(2)=0.21). Across this spectrum of pathophysiology, left ventricular end-systolic wall stress appears to be the key mechanical stimulus influencing cardiac BNP release.

Using mitral 'annulus reversus' to diagnose constrictive pericarditis

To characterize mitral medial and lateral annular velocities in constrictive pericarditis or restrictive cardiomyopathy compared with normal subjects. Tissue Doppler imaging peak systolic velocity (S'), peak early diastolic annular velocity (e'), and timing difference between mitral early flow and early annular movement were measured in 14 patients with constrictive pericarditis, 10 with restrictive cardiomyopathy, and 17 normal subjects using the apical four-chamber view lateral and medial mitral annulus. In controls, mitral lateral e' velocity was 25% higher than medial e' velocity (13.0 +/- 3.1 vs. 10.7 +/- 2.8 cm/s; P = 0.02), whereas with constrictive pericarditis, averaged lateral e' velocity was 2% lower than medial e' velocity (10.7 +/- 2.5 vs. 11.2 +/- 3.1 cm/s; P > 0.05). This relationship represented a reversal of lateral and medial e' velocities compared with normal subjects (P = 0.004). Differences in S', E/e', and timing intervals between normal subjects and patients with constrictive pericarditis were not statistically significant; however, restrictive cardiomyopathy could be distinguished from constrictive pericarditis and controls with all other parameters (S', E/e', medial and lateral e' velocities, and timing interval differences; all P < 0.05). Practical applications of tissue Doppler imaging for evaluation of possible constrictive pericarditis include reversal of the relationship between lateral and medial e' velocities (i.e. 'annulus reversus').

Subclinical Left Ventricular Longitudinal Systolic Dysfunction in Hypertension With No Evidence of Heart Failure

The prevalence of subclinical left ventricular (LV) systolic dysfunction in asymptomatic hypertensive patients was determined using tissue Doppler imaging (TDI). TDI-derived mitral annular velocities were acquired in 35 control subjects, 92 asymptomatic hypertensive patients with no heart failure (HHD), and 15 patients with diastolic heart failure (DHF). No significant intergroup differences in LV ejection fraction were noted. Peak systolic annular velocity was significantly reduced in the DHF group compared with the control and HHD group. Using peak systolic velocity <6.1 cm/s as a cut-off value for abnormal velocity, 10% of HHD patients and 53% of DHF showed impaired LV longitudinal systolic velocity. Peak early diastolic annular velocities were significantly reduced in both the HHD and DHF groups compared with the control group. With multivariable regression analysis, peak early and late diastolic annular velocities, female gender and deceleration time of the E wave velocity were selected as independent predictors for peak systolic annular velocities. Systolic long-axis LV function was impaired in 10% of asymptomatic hypertensive patients. Its reduction was closely correlated with impaired diastolic function. Assessment of LV longitudinal function by TDI plays an important role in identifying diastolic dysfunction and subclinical LV systolic dysfunction in asymptomatic hypertensive patients.

The Effects of Age and Heart Rate on Tricuspid Annular Motion Velocities in Healthy Nonsedated Cats

Background: Age and heart rate have effects on myocardial velocities as assessed by color tissue Doppler imaging (TDI) in people. A similar phenomenon has been identified when left ventricular velocities are assessed in cats. To date, the effects of age and heart rate on tricuspid annular velocities of cats have not been assessed. Objectives: This study was designed to determine the relationships between age and heart rate and tricuspid annular velocities in cats as assessed by 2‐dimensional (2D) color TDI. Animals: Fifty healthy nonsedated cats with age range from 3 months to 19 years old were studied. Methods: Tricuspid annular velocities were obtained with 2D color TDI. Effects of age and heart rate on tricuspid annular velocities were evaluated by simple linear regression. The strength of the linear relationship was determined by using coefficient of determination (R2). Results: A significant weak negative relationship was found between age and peak early diastolic annular velocity (E'; R2= 0.135, P= .018). No significant relationships between age and right ventricular (RV) systolic TDI values were found. Diastolic and systolic TDI parameters were not affected by heart rate with the exception of deceleration rate of early diastolic motion (DR; R2= 0.100, P= .025). Conclusions and Clinical Importance: Age and heart rate have minimal effects on tricuspid annular velocities. The present study provides reference ranges for tricuspid annular velocities in healthy cats and information for assessing the clinical utility of color TDI for evaluation of RV function in cats.

The Effects of Age and Heart Rate on Tricuspid Annular Motion Velocities in Healthy Nonsedated Cats

Age and heart rate have effects on myocardial velocities as assessed by color tissue Doppler imaging (TDI) in people. A similar phenomenon has been identified when left ventricular velocities are assessed in cats. To date, the effects of age and heart rate on tricuspid annular velocities of cats have not been assessed. This study was designed to determine the relationships between age and heart rate and tricuspid annular velocities in cats as assessed by 2-dimensional (2D) color TDI. Fifty healthy nonsedated cats with age range from 3 months to 19 years old were studied. Tricuspid annular velocities were obtained with 2D color TDI. Effects of age and heart rate on tricuspid annular velocities were evaluated by simple linear regression. The strength of the linear relationship was determined by using coefficient of determination (R2). A significant weak negative relationship was found between age and peak early diastolic annular velocity (E'; R2 = 0.135, P = .018). No significant relationships between age and right ventricular (RV) systolic TDI values were found. Diastolic and systolic TDI parameters were not affected by heart rate with the exception of deceleration rate of early diastolic motion (DR; R2 = 0.100, P = .025). Age and heart rate have minimal effects on tricuspid annular velocities. The present study provides reference ranges for tricuspid annular velocities in healthy cats and information for assessing the clinical utility of color TDI for evaluation of RV function in cats.

Tissue Doppler Imaging in the Evaluation of Left Ventricular Function in Young Adults With Autosomal Dominant Polycystic Kidney Disease

Hypertension and increased left ventricular mass index (LVMI) have been reported in patients with early stages of autosomal dominant polycystic kidney disease (ADPKD). Whether these abnormalities are associated with diastolic dysfunction in this stage remains to be established. The aim of the study is to evaluate diastolic function in young normotensive patients with ADPKD by using tissue Doppler imaging (TDI), the most sensitive method available to date. Thirty-two young clinically normotensive patients aged 21 to 30 years were compared with 23 controls with similar ages. Ambulatory blood pressure measurement (ABPM) was performed to confirm normal blood pressure. Subsequently, patients and controls underwent echocardiography using transmitral Doppler and TDI. LVMI was greater in patients with ADPKD than controls (89.3 +/- 17.7 versus 77.6 +/- 15.9 g/m2; P < 0.02). No significant differences were found in transmitral Doppler and TDI results. When ABPMs were taken into account, 11 patients had mild hypertension and showed increased LVMI and decreased early diastolic peak velocity (E wave: 67.0 +/- 12.0 cm/s in hypertensive patients with ADPKD versus 81.4 +/- 3.3 cm/s in normotensive patients with ADPKD versus 79.3 +/- 2.9 cm/s in controls; P < 0.04) and decreased TDI peak early diastolic annular velocity (11.6 +/- 2.8 cm/s in hypertensive patients with ADPKD versus 13.2 +/- 1.6 cm/s in normotensive patients with ADPKD versus 13.4 +/- 1.6 in controls; P < 0.05). Diastolic dysfunction is not a prominent sign in young normotensive patients with ADPKD.

Pulse tissue Doppler analysis of tricuspid annular motion in Iranian children

Quantitative assessment of right ventricular (RV) function has been difficult to assess non-invasively secondary to its non-geometric shape and respiratory-variable filling. With recent improvements in ultrasound equipment we are now able to study myocardial velocity changes, which is known as tissue Doppler imaging. To define normal indices of tricuspid pulse tissue Doppler echocardiography imaging in children and infants. We enrolled 100 healthy children with the age of 1 month-15 year old who were referred for echocardiography and had no cardiac lesion in primary echocardiography evaluations. Pulse tissue Doppler images of the lateral tricuspid annular motion were recorded using 4-chamber apical view. Simultaneous electrocardiography was used to correct annular motion time with electrical events. Among our patients 9 were under 1 year, 46 between 10 and 15, 36 between 5 and 10, and 9 between 10 and 15. Infants had decreased peak early diastolic annular velocities and early diastolic annular velocity-to-diastolic annular velocity at atrial contraction ratios compared with the older group. Isovolumic relaxation time difference was not significant between two different groups. In this group of patients, deceleration time and isovolumic contraction time were lower too. In this study we found out normal values for systolic and diastolic indices of pulse TDI imaging of tricuspid valve in Iranian healthy children. This can be a basis for RV function studies in different congenital cardiac disease.

906-67 Is Mitral Annulus Motion During Early Diastole Active or Passive? Clinical Evidence of Elastic Recoil

It has been postulated that elastic recoil plays an important role in LV filling and its absence or reduction contributes to diastolic dysfunction. Early diastolic motion of the mitral annulus is related to LV recoil. We hypothesized that if elastic recoil promotes LV filling then peak annular velocity should precede peak mitral filling and that diastolic dysfunction would alter this relationship. In order to elucidate this issue we studied the motion of the mitral annulus using Doppler Tissue Imaging (DTI) and compared it with Pulsed Doppler of the mitral inflow in 10 patients with diastolic dysfunction (Group 1) and 10 age-matched controls (Group 2). Group 1 comprised patients with LVH n = 8 and cardiomyopathy n = 2. Mean age was 57 ± 15 years. All were in sinus rhythm. Mitral inflow pulsed Doppler and DTI mitral annular velocities were recorded from the apical 4ch view using an ultrasound machine with DTI capabilities. The following measurements were obtained: peak early diastolic annular velocity (E a ), peak E wave of mitral inflow (E m ), time difference between the onset of annular motion and onset of mitral flow (Δo) and time difference between peak Ea, and peak E m (Δ peak ). Peak E a peak E m Δo Δ peak Group 1 7.3 ± 2 cm/s 94 ± 30 cm/s -1.5 ± 12 msee 7.5 ± 19 msec Group 2 11.3 ± 3 cm/s 61 ± 18 em/s -1 ± 15 msec -22 ± 15 msec p 0.009 0.01 ns 0002 1) In patients with diastolic dysfunction the peak early velocity of annular motion is lower despite higher mitral filling velocities. 2) In normals, the peak velocity of annular motion precedes peak mitral filling. This is reversed in patients with abnormal diastolic function. 3) These data suggest that LV recoil contributes significantly to normal early LV filling.