Copyright © 2005, The European Society of Cardiology
Lateral vs medial mitral annular tissue Doppler in the echocardiographic assessment of diastolic function and filling pressures: which should we use?
aDepartment of Medicine, University of Melbourne, Austin Health, Heidelberg 3084, Australia
bDepartment of Cardiology, Austin Health, Heidelberg 3084, Australia
Received 16 February 2004; received in revised form 22 July 2004; accepted after revision 23 July 2004.
* Corresponding author. Departments of Cardiology and Medicine, University of Melbourne, Austin Health, Burgundy Street, Heidelberg, Melbourne, Victoria 3084, Australia. Tel.: +61 3 9496 5527; fax: +61 3 9459 0971. piyush.srivastava{at}austin.org.au
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Abstract |
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Tissue Doppler echocardiography (TDE) is used in the assessment of diastolic function, however, it is unclear whether the medial (E' med) or lateral (E' lat) annulus should be used. Our aim was to compare the diagnostic utility of E' med and E' lat. In 232 subjects left ventricular (LV) systolic and diastolic function was assessed via transthoracic echocardiography with TDE measurements obtained from both annuli. LV function was normal in 91 subjects (39%), with diastolic dysfunction found in 141 subjects (61%). TDE velocities decreased with age and progressive diastolic dysfunction for either annulus. E' med recorded significantly lower myocardial velocities than E' lat. Receiver operator curves showed improved area under the curve (AUC) for E' med than E' lat. Furthermore the AUC was significantly improved compared to E/A ratio and deceleration time. For diagnosing diastolic dysfunction, an E' med<11cm/s provided a sensitivity of 78%, specificity of 67% and positive predictive value of 70%. Whilst for diagnosing elevated filling pressures an E/E' medial ratio>8 provided values of 56%, 93% and 91%, respectively. In conclusion, although either annulus can be used, E' med provides better diagnostic utility.
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