Left Ventricular Diastolic Function Assessment using the Timing of Mitral Annular and Transmitral Flow Velocities

Background and aims: Evaluation of left ventricular (LV) diastolic function plays an important role in clinical echocardiography. The relationship between mitral annular velocities from tissue Doppler imaging (TDI) (E' and A') and mitral inflow velocities (E and A) from Doppler echocardiography (DE) provide additional information about LV filling and diastolic function. The aims of this study are to i) assess the time differences between peak E and peak E', peak A and peak A', peak Ar and peak A, and ii) examine the effects of age and gender on these time intervals parameters in normal subjects. Methods: A total of 117 healthy subjects (age ranging from 22-to 78-years-old) were recruited for a standard of echocardiogram (ECHO). During early diastole, the time intervals from the peak of R-wave on the ECG to the peak of E-wave (R-pE), to the peak of E wave to peak of E'-wave (R-pE') were measured. During late diastole, the time intervals from the onset of P-wave on the ECG to the peak A-wave (P-pA), to the peak Ar-wave on the pulmonary valve flow (P-pAr), to the peak A'-wave (P-pA') were measured. Early-diastolic temporal discordance (EDTD) and late-diastolic temporal discordance (LDTD) were calculated as the differences between (R-pE) and (R-pE'), and (P-pA) and (P-pA'), respectively. Results: The mean EDTD and LDTD were 28.7 +/- 10.6 ms and 21.2 +/- 15.9 ms, respectively. Similarly, the mean time difference [(P-pA) -(P-pAr)] was 21.5 +/- 14.1 ms. EDTD was not associated with age (r= 0.15, p= NS), while LDTD was inversely correlated with age (r=-0.65, p< 0.01). No significant differences were found for both EDTD and LDTD between genders. Conclusion: EDTD and LDTD, the temporal discordances between mitral annulus motion and trans-mitral flow, embody one of the earliest events at early-and late-diastole. Age is not associated with EDTD, but is accompanied by a decline in LDTD. With respect to gender, both EDTD and LDTD are not influenced.