Abstract
The aim of this study is to assess the left ventricular filling and estimate the end-diastolic pressure of the left ventricle in patients with coronary artery disease (CAD) by echocardiographic measurement of the atrioventricular plane displacement (AVPD). In 101 patients (mean age 59 ±12 years) with CAD, a complete transthoracic echocardiographic study was performed, just prior to cardiac catheterization. The AVPD was recorded by Mmode echocardiography, from apical four and two chamber views. The recordings were obtained at four sites, corresponding to the septal, lateral, anterior and inferior walls of the left ventricle. The mean AVPD resulting from atrial systole (At), the mean total (T) diastolic AVPD, the ratio At/T(%) and the ratio of mitral annulus excursion during early and late diastole [(T-At)/At] were calculated. Firty-two age-matched healthy subjects served as control group. Both At and At/T were significantly greater in patients with CAD than in the controls (6.06 ±0.94 vs 5.53 ±0.55 mm, p<0.01 and 43.4 ±5.9% vs 33.49 ±4.45%, p<0.001 respectively). The ratio [(T-At)/At] correlated with the E/A ratio of transmitral flow, both in healthy subjects (r=0.850, p<0.001) and in patients with CAD (r = 0.722, p<0.001). Correlation also existed both in patients with segmental wall motion abnormality (SWMA) (r = 0.691, p<0.001) and in patients with SWMA (r=0.818, p<0.001). In patients with CAD, At/T further correlated with the left ventricular end-diastolic pressure (r=0.517, p<0.001). In patients with SWMA and in patients without, a correlation was also found (r=0.516, p<0.001 and r=0.566, p<0.001 respectively). In conclusion, AVPD measured by echocardiography can be used as a simple noninvasive parameter to evaluate left ventricular filling in patients with CAD and for the gross estimation of end-diastolic pressure of left ventricle.
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Walmsley R, Watson H. Clinical Anatomy of the Heart, Edinburg, Churchill Livingstone, 1978: 91–112.
Perloff JK, Roberts WC. The mitral apparatus. Functional anatomy of mitral regurgiation. Circulation 1972; 46: 227–32.
Holmgren BS. The movements of the mitroaortic ring recorded simultaneously by cineroentgenography and electrocardiography. Acta Radiol 1946; 27: 171–6.
Undewood SR, Gill CRW, Firmin DN et al. Left ventricular volume measured rapidly by oblique magnetic resonance imaging. Br Heart J 1988; 60: 188–95.
Alam M. The atrioventricular plane displacement as a means of evaluating left ventricular systolic function. Clin Cardiol 1991; 14: 588–94.
Alam M, Hoglund C, Thorstrand C, Philip A. Artioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Intern Med 1990; 228: 569–75.
Pai GR, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral annulus as an index of left ventricular systolic function. AmJCardiol 1991; 67: 222–4.
Alam M, Hoglund C, Thorstrand C, Hellekant C. Haemodynamic significance of the atrioventricular plane displacement in patients with coronary artery disease. Eur Heart J 1992; 13: 194–200.
Simonson JS, Schiller NB. Descent of the base of the left ventricle: An echocardiographic index of left ventricular function. J Am Soc Echocardiog 1989; 2: 25–35.
Alam M, Hoglund C. Assessment by echocardiogram of left ventricular diastolic function in healthy subjects using the atrioventricular plane displacement. Am J Cardiol 1992; 69: 505–65.
Savage DD. Prevalence and evolution of echocardiographic left ventricular hypertrophy. The heart and hypertention. Messerli FH, (ed). York Medical Books, N.Y., 1987: 63–71.
Sahn DJ, De Maria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: Results of a survey of echocardiographic measurement. Circulation 1978; 58: 1072–83.
Henry WL, De Maria A, Gramiak R, King DL, Kisslo JA, Popp RL et al. Report of the American Society of Echocardiography Committee on the Nomenclature and Standards in 2-D echocardiography. Circulation 1980; 62: 212–7.
Zaky A, Grabhoru L, Feigenbaum H. Movement of the mitral ring: A study in ultrasonocardiography. Cardiovasc Res 1967; 1: 121–31.
Rokseth R, Helle I, Marstrander F, Storstein O. Reference level in pressure recordings during right heart catheterization. Scand J Clin Lab Invest 1960; 12: 116–20.
Sandier H, Dodge HT. The use of single plane angiocardiograms for the calculation of left ventricular volume in man. Am Heart J 1968; 75: 325–34.
Nishimura RA, Able MD, Hatle LK, Tajin JA. Assessment of diastolic function of the heart: Background and current applications of Doppler echocardiography. Mayo Clin Proc 1989; 64: 181–204.
Ormistou JA, Shah PM, Tei C, Wong M. Size and motion of the mitral valve annulus in man. Circulation 1981; 64: 113–20.
Sokolow M, McIlroy MB. Clinical Cardiology, 4th ed. Los Altos: Lange Medical Publications, 1986:41.
McDonald IG. The shape and movements of the human left ventricle during systole. A. Study by cineangiography and by cineradiographyofepicardial markers. Am J Cardiol 1970; 26: 221–30.
Alam M, Rosenhamer G. Atrioventricular plane displacement and left ventricular function. J Am Soc Echocardiogr 1992; 5: 427–33.
Alam M, Hoglund C, Thorstrand C, Carlens P. Effects of exercise on the displacement of the atrioventricular plane in patients with coronary artery disease. A new echocardiographic method of detecting reversible myocardial ischaemia. Eur Heart J 1991; 12: 760–5.
Keren G, Sonnenblick E, Le Jemtel TK. Mitral annulusmotion. Relation to pulmonary venous and transmitral flows in normal subjects and in patients with dilated cardiomyopathy. Circulation 1988; 78: 621–9.
Benjamin EJ, Levy DI, Anderson KM, Wolf PA, Plehn JF, Evans JC et al. Determinants of Doppler indexes of left ventricular diastolic function in normal subjects. Am J Cardiol 1992; 70: 508–15.
Gerwirtz H, Oliley W, Walsh J, Shearer D, Sullivan MJ, Most AS. Ischemia induced impairment of left ventricular relaxation: Relation to reduced diastolic filling rates of the left ventricle. Am Heart J 1983; 105: 72–80.
Stoodard MF, Pearson AC, Kern M Jr, Katcliff J, Mrosek DG, Labovitz AS. Left ventricular diastolic function: Comparison of pulsed Doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease. J Am Coll Cardiol 1989; 13: 327–36.
Appleton CP, Hatle LK, Popp RL. Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–40.
Hoglund C, Alam M, Thorstrand C. Effects of acute myocardial infarction on the displacement of the atrioventricularplane: An echocardiographic study. J Intern Med 1989; 226: 251–6.
Mulragh S, Quinones MA, Kleiman NS, Cheirif J, Zoghbi W. Estimation of left ventricular end-diastolic pressure from Doppler transmitral flow velocity in cardiac patients independent of systolic performance. J Am Coll Cardiol 1992; 20: 112–9.
Channer KS, Culling W, Wilde P, Jones JV. Estimation of left ventricular end-diastolic pressure by pulsed Doppler ultrasound. Lancet 1986; 1: 1005–7.
Rossvoll O, Hatle LV. Pulmonary venous flow velocities recorded by transhoracic Doppler ultrasound: Relation to left ventricular diastolic pressures. J Am Coll Cardiol 1993; 21: 1687–96.
Topol EJ, Traill TA, Fortuin NJ. Hypertensive hypertrophic cardiomyopathy of the elderly. N Engl J Med 1985; 312: 277–83.
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Kranidis, A., Kostopoulos, K., Margaris, N. et al. Significance of echocardiographic atrioventricular plane displacement for the evaluation of left ventricular filling and end-diastolic pressure in patients with coronary artery disease. Int J Cardiac Imag 11, 185–192 (1995). https://doi.org/10.1007/BF01143108
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DOI: https://doi.org/10.1007/BF01143108