Doppler tissue analysis of mitral annular velocities: evidence for systolic abnormalities in patients with diastolic heart failure

The presence of signs and symptoms of heart failure (HF), abnormal diastolic function and an ejection fraction > 45%, have been defined as diastolic HF (DHF). However, a cut-off value of 45% for ejection fraction seems arbitrary as mild systolic dysfunction may be overlooked. It was the goal of this study to assess the additive information derived from Doppler tissue imaging for patients with DHF. As a measure of left ventricular (LV) long-axis function, systolic and diastolic velocities of the mitral annulus (peak, peak early, and peak late) derived from pulsed Doppler tissue imaging were assessed in 36 asymptomatic control subjects, 36 patients with DHF, and 35 patients with systolic HF (SHF). As a measure of overall LV performance, the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time) was assessed. In the DHF group, peak systolic annular velocity was reduced (7.1 ± 1.2 cm/s) as compared with the control group (9.0 ± 1.2 cm/s, P < .05), and was even lower in the SHF group (5.0 ± 0.7 cm/s, P < .01 SHF group vs DHF/control groups). The Tei index was increased in the DHF group (0.53 ± 0.14) in comparison with the control group (0.39 ± 0.07, P < .05), and was highest in the SHF group (0.94 ± 0.43, P < .01 SHF group vs control/DHF groups). Using peak systolic annular velocity < 7.95 cm/s as a cut-off value (derived from receiver operating characteristic curve analysis), patients with DHF were separated from control subjects with a sensitivity of 83% and a specificity of 83%. A Tei index > 0.43 separated patients with DHF and control subjects with a sensitivity of 79% and a specificity of 72%. Systolic long-axis LV function is also impaired in patients with DHF, resulting in feasible diagnosis of DHF by Doppler tissue imaging analysis of LV long-axis function and overall LV function with the Tei index.