ASSESSMENT OF DIASTOLIC DYSFUNCTION BY TISSUE DOPPLER IMAGING AND AUTOMATED BORDER DETECTION IN THE PRESENCE OF PSEUDONORMAL MITRAL INFLOW PATTERN.

In order to establish whether echocardiographic tissue Doppler imaging (TDI) and automated border detection (ABD) help to distinguith normal from pseudonormal left ventricular (LV) filling in patients (pts) with diastolic dysfunction, we studied with TDI and ABD 23 pts with heart disease that presented pseudonormal pattern (E/A ratio 1-1.5, isovolumetric relaxation time 60-100 ms, deceleration time 150-200 ms, pulmonary vein atrial reversal > 35 cm/s). 18 age-matched subjects with no signs of heart disease were selected as normal controls (CTR). TDI wall velocities during systole (Sa), early relaxation (Ea) and atrial systole (Aa) were measured in the mitral annulus. The following LV filling ABD parameters were calculated: rapid filling phase fractional change (RFFC), atrial filling phase fractional change (AFFC), peak rapid filling rate (PRFR), peak atrial filling rate (PAFR). TDI showed decreased Sa and Ea velocities and Ea/Aa ratio compared to CTR (Sa=5.8 +/- 1.9 vs 9.6 +/- 2.1 cm/s, p<0.005; Ea=8.1 +/- 2.1 vs 14.2 +/- 4.1 cm/s, p<0.001; Ea/Aa=0.89 +/- 0.41 vs 1.48 +/- 0.32, p<0.001). ABD showed decreased RFFC/AFFC ratio and PRFR/PAFR ratio compared to CTR (RFFC/AFFC 1.28 +/- 0.38 vs 2.61 +/- 0.49, p<0.001; PRFR/PAFR 0.91 +/- 0.39 vs 1.95 +/- 0.44, p<0.001). Thus, both TDI and ABD are useful in the evaluation of diastolic dysfunction even in the presence of pseudonormalized Doppler indices.