Comparison of myocardial tissue Doppler with transmitral flow Doppler in left ventricular hypertrophy

We sought to determine the most useful echocardiographic measurements for assessment of diastolic function in patients with left ventricular hypertrophy (LVH) and normal systolic function. We compared myocardial Doppler velocities of the basal inferoposterior wall with mitral inflow pulsed wave Doppler velocities in 11 healthy volunteers (age, 36 ± 6 years), 25 patients (age, 64 ± 14 years) without LVH, and 37 patients (age, 67 ± 14 years) with LVH and otherwise normal echocardiograms. The discriminatory measurements were myocardial A-wave duration (120 ± 18 versus 98 ± 20 and 92 ± 12 ms, P < .0001), myocardial isovolumetric relaxation time (124 ± 45 versus 95 ± 48 and 78 ± 25 ms, P = .0035), mitral A-wave velocity (0.98 ± 0.37 versus 0.73 ± 0.28 m/s and 0.61 ± 0.22 m/s, P = .009), and mitral E-wave deceleration time (257 ± 93 versus 201 ± 85 ms and 184 ± 83 ms, P = .015), which were significantly increased, and myocardial E-wave velocity (0.84 ± 0.04 m/s versus 0.13 ± 0.03 m/s and 0.14 ± 0.03 m/s, P < .0001), which was significantly decreased, in patients with LVH compared with patients without LVH and normal volunteers, respectively. Left ventricular posterior wall thickness correlated with myocardial isovolumetric relaxation time (r = 0.52, P < .0001) and myocardial A-wave duration (r = 0.59, P < .0001), negatively with myocardial E wave (r = -0.43, P < .0001), and showed no correlation with mitral inflow parameters except mitral inflow A wave (r = 0.43, P = .002). On multivariate analysis using these variables, myocardial isovolumetric relaxation time (P = .0014) and A-wave duration (P = .001) were the only 2 variables that correlated with posterior wall thickness (multiple R = 0.71). In the presence of LVH and preserved left ventricular systolic function, myocardial relaxation time and velocities are more sensitive than mitral Doppler inflow parameters in detecting abnormal left ventricular relaxation.