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European Heart Journal 1995 16(7):943-950;
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Diastolic mitral annular motion in normal subjects and patients with coronary artery disease

N. OHTE, H. NARITA, T. HASHIMOTO, K. KOBAYASHI, S. AKITA and T. FUJINAMI

The Third Department of Internal Medicine, Nagoya City University Medical School Nagoya, Japan

revised 23 August 1994; accepted 28 October 1994.

Correspondence: Nobuyuki Ohte, MD, Section of Cardiology, Bowman Gray School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, U.S.A.

Abstract

The purpose of this study was to evaluate the characteristics of mitral annular motion during diastole in 28 normal subjects, 40 patients with prior myocardial infarction (MI), and 23 patients with coronary artery disease but without prior MI. Mitral annular motion during diastole was obtained from the apex by M-mode echocardiography at the posterior wall of the left ventricle. Determinants of mitral annular excursion during early (MAE-E) and late diastole (MAE-L) were investigated in all subjects. Differences in the MAE-E, MAE-L, and the MAE-L.MAE-E ratio were compared among the three patient groups. The Doppler-derived transmitral flow velocity-time integral during early (El) and late (AI) diastole and mitral annular excursions during diastole were obtained in 55 other patients with a prior MI and in 29 healthy volunteers. The relationships between the MAE-L: MAE-E ratio and AI: EI ratio in these two groups were studied.

The MAE-E was determined mainly by heart rate and left ventricular ejection fraction (LVEF). The MAE-L was determined only by age. The magnitude of MAE-E was significantly less in patients with a prior MI than in normal subjects (P<0.01). However, the MAE-L did not differ among the three groups. The MAE-L.MAE-E was higher in patients with a prior MI than in normal subjects (P<0.05), and was significantly correlated with AI: EI in healthy volunteers (r={theta}0.65, P<0.001) and in patients with a prior MI (r={theta}0.50, P<0.001).

The MAE-E in patients with a prior MI decreases in proportion to the deterioration in LVEF. The relative at rial contribution to left ventricular longitudinal distension is increased in patients with a prior MI and diastolic mitral annular motion has a significant relationship to the transmitral flow. These findings suggest that mitral annular motion during late diastole plays an important role in maintaining left ventricular filling in patients whose left ventricular systolic function has deteriorated.

Key Words: Mitral annular motion • M-mode echocardiography • left ventricular fulling • Doppler echocadiography • coronary artery disease


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