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Value of E wave propagation velocity in differentiating between normal and pseudonormal mitral inflow pattern.

Karina Wierzbowska, Jarosław D. Kasprzak, Jarosław Drożdż, Paulina Wejner-Mik, Maria Krzemińska-Pakuła
IMW AM, Łódź

Evaluation of diastolic function in routine echocardiogram is often limited to mitral inflow pattern. As mitral flow in advanced diseases resembles normal pattern (pseudonormalisation) other parameters are needed for correct assesment of diastolic dysfunction.

Our aim was to assess E wave propagation velocity (Ep) in patients with left ventricle dysfunction after myocardial infarction and in age matched group of healthy persons and to determine its value in differentiation between normal and pseudonormal inflow pattern.
We included 80 persons: 40 consecutive patients after myocardial infarction (25 male, mean age 62 ± 10, mean ejection fraction 42%) and 40 age matched healthy volunteers. Transthoracic echocardiography with assessment of ejection fraction, mitral flow with E to A wave velocity ratio and Ep (M-mode color Doppler recording) was performed. In group with LV dysfunction patients with normal E to A ratio were selected (pseudonormalised mitral flow) and Ep in this group was compared with controls. After establishing cut-off value for Ep, its significance for predicting of severe diastolic dysfunction was assessed. Mean E wave propagation velocity was 26 cm/s (SD ± 10) in group after myocardial infarction and differed significantly from healthy persons: 47 cm/s (SD ± 8), p<0,0001. Also difference in Ep between pseudonormalised and normal mitral flow groups was significant: 27 cm/s (SD ± 10) vs 47 cm/s (SD ± 8) p<0,0001. For Ep value equal or lower then 33 cm/sek sensitivity, specificity, accuracy positive predictive value and negative predictive value for detection of severe diastolic dysfunction (classified as pseudonormal or restrictive pattern) were respectively: 76%, 68%, 62%, 81% and 71%.

CONCLUSIONS: E wave propagation velocity is easily obtainable parameter which offers significant potential in differentiating normal and pseudonormal mitral flow pattern and improves quantitative assessment of diastolic function.








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