Significance of Doppler Derived Mitral A Wave Deceleration Time : for Evaluation of Diastolic Dysfunction in Patients with Ischemic Heart Disease

Han, Seong Wook; Kim, Kee Sik; Hur, Seung Ho; Hyun, Dae Woo; Kim, Yoon Nyun; Kim, Kwon Bae

Abstract

BACKGROUND
The changes of mitral flow pattern obtained by pulsed wave Doppler echocardiography are widely used for the evaluation of left ventricular diastolic function. In the evaluation of left ventricular pressure with corresponding mitral flow velocity, left ventricular end-diastolic pressure(LVEDP) correlate with A wave in mitral flow. Therefore, changes of Doppler derived A wave may be new parameters for evaluating of left ventricular diastolic dysfunction. We studied relationship between LVEDP and changes of A wave in patients with ischemic heart disease.
METHODS
LVEDP was observed in 68 patients among patients who underwent coronary angiography between January and June, 1996. Thirty two patients had a LVEDP less than 20mmHg(Group I) and 36 patients had a LVEDP greater than 20mmHg(Group II). In all patients, adequate pulsed Doppler mitral inflow velocity could be recorded within 24 hours before coronary angiography and cardiac catheterization.
RESULTS
A wave deceleration time(A DT) was significantly decreased in Group II patients (Group I vs Group II, 69.3±11.7 vs 56.5±15.6 msec, p < 0.05). Isovolumic relaxation time (IVRT) was significantly decreased in Group II patients, too(118.4±17.9 vs 104.6±27.9 msec, p < 0.05). Another Doppler derived mitral flow parameters were not significantly different between two groups. E/A ratio showed positive correlation with LVEDP(n=68, r=0.29, p < 0.05, y=1.62ex+0.77). A DT and IVRT showed negative correlation with LVEDP(n=68, r=0.28, p < 0.05, y=-0.83x+128.22 and n=68, r=0.24, p < 0.05,y=-0.45x+71.74 respectively).
CONCLUSION
We can suggest that A wave deceleration time can be used as a new parameter for the evaluation of left ventricular diastolic dysfunction.