Reduced Early Diastolic Mitral Annulus Acceleration by Tissue Doppler Imaging in Grade 1 Left Ventricular Diastolic Dysfunction

Reduction of the early diastolic mitral annulus velocity by tissue Doppler imaging (TDI) has been found in patients with left ventricular diastolic dysfunction. Observations in our echo lab suggested that in patients with impaired relaxation, not only is this velocity reduced, but the time to peak velocity (TPV), a reflection of the acceleration of the annulus in early diastole, is prolonged. Twenty-nine patients with Grade 1 diastolic dysfunction were compared with 23 normal patients. All patients in both groups had normal systolic function and ejection fraction. Patients with impaired relaxation showed on average a prolonged TPV and a flatter slope, compared with the shorter TPV and steeper slope seen in the normal patients. None of the normal patients had a TPV greater than 70 msec, while 62% of the impaired relaxation patients had a TPV greater than 70 msec. Thus, this study suggests that patients with mild diastolic dysfunction have a reduction of mitral annulus acceleration in early diastole as shown by a prolonged TPV.