Background. Left Ventricular (LV) diastolic performance is impaired in patients with aortic regurgitation (AR). The objective of this study is to determine the effect of AR jet direction on left ventricular diastolic performance.
Methods. 20 patients with significant AR [regurgitant fraction (RF) > 30%] were studied by 2-dimensional, color, pulsed and tissue Doppler echocardiography. Subjects were divided into two groups based on jet direction as observed on the parasternal long-axis color flow image. Ten patients had the jet directed onto the anterior mitral leaflet (AML, mitral group) and 10 had the jet directed to the center of the LV (central group). Patients with significant mitral regurgitation or pseudonormal LV hemodynamics were excluded. The isovolumic contraction and relaxation times (ICT and IRT) were measured by combined mitral inflow and LV outflow velocity waves. Mitral annulus velocity was measured at the lateral annulus on the apical 4-chamber view by pulsed Doppler tissue imaging. The RF was calculated by combined use of pulsed Doppler and 2-dimensional echocardiography.
Results. The two groups were similar in age, AR grade, LV end-diastolic volume, LV ejection fraction, and ICT; where-as, significant differences existed in the mitral inflow E/A ratio (mitral group, 0.59±0.17 vs. central group, 1.15±0.46, p<0.01), IRT (mitral group, 104±24 msec vs. central group, 83±15 msec, p<0.01), and mitral annulus velocity during early diastole (mitral group, 5.8±2.0 cm/sec vs. central group, 10.0±2.0 cm/s, p<0.01).
Conclusions. LV diastolic performance is altered when a regurgitant jet is directed onto the AML in patients with significant AR.
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