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To assess the left ventricular (LV) diastolic function in patients with normal mitral E/A and annulus e'/a' ratios but decreased left ventricular contraction by echocardiography, and discuss formation mechanism of this unusual echo performance.
Tei index, multiple mitral and pulmonary venous flow Doppler parameters and mitral annular tissue Doppler parameters of case group (Group A) were measured by two-dimensional (2D) echocardiography. The findings were compared with those of control groups which were divided into four groups according to mitral E/A and annulus e'/a' ratios, including Group B0 with normal LV diastolic function, Group B1 with impaired LV relaxation, Group B2 with pseudonormalized filling and Group B3 with restrictive filling. The left atrial and ventricular volume-time curves of each group were also depicted by real-time three-dimensional (3D) echocardiography and 3D parameters, such as atrial or ventricular volume index, atrial emptying fraction, were measured based on them.
① Tei index and most 2D diastolic function parameters of Group A, such as IVRT, EDT, E/e’, e’, PVS, PVD, etc, were abnormal. Compared with Group B0, the left atrial and ventricular volume indexes in different phases were all significant statistically increased (all P<0.001); ② Some 2D diastolic function parameters including E/e’, EDT and PVS/(PVS+PVD) presented increasing or decreasing trend in order of Group B1, B2, A to B3; ③ Compared with Groups B0, B1 and B2, the second peak of the left atrial (LA) volume-time curve in late diastole was low or disappeared, and the plateau disappearance and the main peak retroposition of the LV volume-time curve in late diastole were also found in Groups A and B3 ;④ The atrial and ventricular volume indexes of Group A were significant statistically higher than Groups B1 and B2, but lower than Group B3(all P<0.01). The LA emptying fraction of Group A was significantly lower than Group B1 and B2, but higher than Group B3 (all P<0.01). SV between case and control groups had no statistically significant difference (all P> 0.05).
The LV diastolic function of case group is definitely reduced, with pseudonormalized E/A ratio and e'/a' ratio. Their damage degree is most probably between traditional diastolic mild dysfunction (pseudonomalized filling) and severe dysfunction (restrictive filling). The unusual echo performance might result from reduced LV relaxation and compliance, decreased LA contraction and continuous high pressure of left atrial and ventricle.