Additional value of lateral tissue Doppler imaging in the assessment of diastolic dysfunction among subjects with pseudonormal pattern of mitral inflow

BACKGROUND There has been a lack of research on further stratification of subjects who have pseudonormal pattern of mitral inflow. The study aim was to clarify 2 different groups with different diastolic function grades among these subjects using lateral tissue Doppler imaging (TDI). METHODS A total of 122 consecutive subjects showing pseudonormal pattern of mitral inflow (E/A ≥ 1 and septal e'/a' < 1) without structural abnormality were prospectively recruited. TDI measurements were performed from both septal and lateral mitral annuli. RESULTS Study subjects were stratified according to lateral TDI pattern (e'/a' < 1 [n = 50] versus e'/a' ≥ 1 [n = 72]). Subjects with lateral e'/a' < 1 had higher values of left atrial volume index (LAVI) and E/e' compared to those for lateral e'/a' ≥ 1 (p < 0.001 for each). Among subjects with lateral e'/a' ≥ 1, only 9.3% of subjects had grade II diastolic dysfunction, whereas among subjects with lateral e'/a' < 1, majority of subjects (64.1%) had grade II diastolic dysfunction (p < 0.001). Multiple linear regression analysis showed that lateral e'/a' was independently associated with LAVI (β = -0.484, p < 0.001), even after adjusting for potential confounders including age, sex, body mass index, hypertension and diabetes. CONCLUSIONS In subjects without structural abnormality showing E/A ≥ 1 and septal e'/a' < 1, lateral TDI measurement is useful in the assessment of diastolic dysfunction. Lateral e'/a' ≥ 1 is a valuable indicator of early diastolic dysfunction but not of advanced diastolic dysfunction in this population.