Associations between Subclinical Myocardial Dysfunction and Premature Fusion of Early and Late Diastolic Filling with Uncertain Cause
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Purpose: The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is oftenfound during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clini-cal implications of premature E-A fusion of uncertain cause in the absence of tachycardia. Materials and Methods: We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between Janu-ary 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates lessthan 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) werecompared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion. Results: The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV di-astolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msecvs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%,p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred atlower heart rate, the |LV GLS| was also lower (p for trend=0.002). Conclusion: Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based in-dices and LV GLS are helpful for evaluating this easily overlooked population.
Abstract
Purpose: The fusion of early (E) and late diastolic filling (A) on mitral inflow Doppler, even in the absence of tachycardia, is oftenfound during assessment of left ventricular (LV) diastolic function. We evaluated the echocardiographic characteristics and clini-cal implications of premature E-A fusion of uncertain cause in the absence of tachycardia. Materials and Methods: We identified 1014 subjects who showed E-A fusion and normal LV ejection fraction (LVEF) between Janu-ary 2019 and June 2021 at two tertiary hospitals. Among these, 105 (10.4%) subjects showed premature E-A fusion at heart rates lessthan 100 beats per minute (bpm). The conventional echocardiographic parameters and LV global longitudinal strain (GLS) werecompared with 1:1 age-, sex-, and heart rate-matched controls without E-A fusion. Results: The premature E-A fusion group had a heart rate of 96.4±3.7 bpm. Only 4 (3.8%) subjects were classified as having LV di-astolic dysfunction according to current guidelines. The group showed prolonged isovolumic relaxation time (107.2±25.3 msecvs. 61.6±15.6 msec, p<0.001), increased Tei index (0.76±0.19 vs. 0.48±0.10, p<0.001), lower LVEF (63.8±7.0% vs. 67.3±5.6%,p<0.001) and lower absolute LV GLS (|LV GLS|) (17.0±4.2% vs. 19.7±3.3%, p<0.001) than controls. As the E-A fusion occurred atlower heart rate, the |LV GLS| was also lower (p for trend=0.002). Conclusion: Premature E-A fusion at heart rates less than 100 bpm is associated with subclinical LV dysfunction. Time-based in-dices and LV GLS are helpful for evaluating this easily overlooked population.
참고문헌 (39)
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