906-67 Is Mitral Annulus Motion During Early Diastole Active or Passive? Clinical Evidence of Elastic Recoil

It has been postulated that elastic recoil plays an important role in LV filling and its absence or reduction contributes to diastolic dysfunction. Early diastolic motion of the mitral annulus is related to LV recoil. We hypothesized that if elastic recoil promotes LV filling then peak annular velocity should precede peak mitral filling and that diastolic dysfunction would alter this relationship. In order to elucidate this issue we studied the motion of the mitral annulus using Doppler Tissue Imaging (DTI) and compared it with Pulsed Doppler of the mitral inflow in 10 patients with diastolic dysfunction (Group 1) and 10 age-matched controls (Group 2).MethodsGroup 1 comprised patients with LVH n=8 and cardiomyopathy n=2. Mean age was 57±15 years. All were in sinus rhythm. Mitral inflow pulsed Doppler and DTI mitral annular velocities were recorded from the apical 4ch view using an ultrasound machine with DTI capabilities. The following measurements were obtained: peak early diastolic annular velocity (Ea), peak E wave of mitral inflow (Em), time difference between the onset of annular motion and onset of mitral flow (Δo) and time difference between peak Ea, and peak Em(Δpeak).ResultsPeak Eapeak EmΔoΔpeakGroup 17.3±2cm/s94±30cm/s-1.5±12 msee7.5±19msecGroup 211.3±3cm/s61±18 em/s-1±15msec-22±15msecp0.0090.01ns0002Conclusion1) In patients with diastolic dysfunction the peak early velocity of annular motion is lower despite higher mitral filling velocities. 2) In normals, the peak velocity of annular motion precedes peak mitral filling. This is reversed in patients with abnormal diastolic function. 3) These data suggest that LV recoil contributes significantly to normal early LV filling