Left Ventricular Diastolic Filling in Dilated Cardiomyopathy: Pulsed Doppler Echocardiographic Study

Kim, Kwon Sam; Kim, Young Soo; Choue, Chung Whee; Kim, Myung Shick; Song, Jung Sang; Bae, Jong Hoa

Abstract

Abnormal left ventricular diastolic properties have been reported in dilated cardiomyopathy (DC). Characteristics of transmitral flow were analysed in 37 patients with DC and 29 age matched normal subjects by pulsed Doppler echocardiography. Peak flow velocity of early diastole(PFVE, E), atrial systole (PFVA, A), E/A and deceleration rate of early diastolic flow (DEF) were measured from mitral Doppler spectrum. The extent of mitral regurgitation (MR) was determined by mapping method in the left atrium. Significant mitral regurgitation was founded in 27 out of 37 patients. Three distinct transmitral flow velocity patterns were demonstrated. Ten Patients without significant MR(27%, group 1), PFVE(58+/-17 cm/s), PFVA(73+/-17 cm/s) and E/A (0.94+/-0.4) were significant different from normal subjects (73+/-11 cm/s, 61+/-11 cm/s, 1.22+/-0.26, P<0.025, P<0.005, P<0.05, respectively). In contrast 17 patients with significant MR(46%, group 2) showed higher E (89+/-24 cm/s), lower A(52+/-19 cm/s), higher E/A (1.83+/-0.6) and DEF (596+/-149 cm/s2) than group 1 patients. Remained 10 cases (27%, group 3) had higher single peak flow (104+/-25 cm/s) with higher DEF and significant MR. In conclusion, abnormalities of left ventricular filling are detected in dilated cardiomyopathy without MR but not in DC with MR by Doppler echocardiography. The presence of MR, which augments early diastolic filling, may mask abnormal diastolic filling properties of DC.