Comparison of early diastolic annular velocities measured at various sites of mitral annulus in detection of mild to moderate left ventricular diastolic dysfunction.

Early diastolic mitral annular velocity (Em) as measured by pulsed-wave tissue Doppler echocardiography (PW-TDE) has been described as a relatively load independent index of left ventricular (LV) relaxation allowing more precise assessment of LV diastolic function. Nevertheless, substantial regional differences in Em are encountered. A systematic study comparing accuracy of the Em values measured at various annular sites in the assessment of LV diastolic function is still lacking. In this study we aimed to compare the discriminating power of Em velocities measured at the various sites of the mitral annulus in distinguishing between normal LV filling and mild to moderate LV diastolic dysfunction, and to determine the optimal cutoff values of Em at each mitral annular site. Em determined by PW-TDE was measured at four mitral annular sites in 69 patients with various heart diseases and compared to LV filling patterns obtained using standard flow Doppler indices. A comparison of receiver operating characteristic curves did not show significant differences for areas under the curve in favor of Em measured at any annular site (0.92 for septal, 0.96 for lateral, 0.96 for inferior and 0.93 for anterior site, 0.95 for the averaged value of Em from all annular sites, and 0.93 for the averaged value from septal and lateral sites, P not significant). The optimal cutoff values of Em were 0.08 m s(-1) for septal site (91% sensitivity, 89% specificity), 0.11 m s(-1) for lateral site, 0.09 m s(-1) for inferior site (both 91% sensitivity, 94% specificity), 0.10 m s(-1) for anterior annular site (88% sensitivity, 91% specificity), 0.11 m s(-1) for the averaged value of Em from all sites, and 0.11 m s(-1) for the averaged value from septal and lateral sites (both 97% sensitivity, 86% specificity). There are no differences in the accuracy of Em velocities obtained at various mitral annular sites regarding the detection of mild to moderate LV diastolic dysfunction. However, different cutoff values of Em at each mitral annular site must be considered for distinguishing between normal and mild to moderate LV diastolic dysfunction.