Sir,—We read with interest the study by Willenheimer et al regarding the prognostic significance of left atrioventricular plane displacement (AVPD) in patients with heart failure.1 This study showed that mortality in patients with heart failure is strongly related to systolic left atrioventricular plane motion. The movement of the left atrioventricular plane is a result of the longitudinal shortening of left ventricular fibres. During systole, the contraction of the longitudinal fibres of the left ventricle leads to a descent of the atrioventricular plane towards the relatively immobile cardiac apex. It should not be forgotten that assessment of left ventricular systolic function by cross sectional echocardiography is sometimes difficult because endocardium is inadequately visualised, especially in the elderly. In contrast, the mitral ring is distinctly outlined and easily studied by m mode recording,2-4 and, as it was related to mortality in cardiac failure patients,m mode echocardiography was recommended for general use.1

Willenheimer et al proposed further studies of the effects of different drugs on systolic AVPD. We recently assessed the value of left AVPD during low dose dobutamine infusion to predict functional improvement of asynergic infarcted myocardial …