The Mitral Annular Middiastolic Velocity Curve: Functional Correlates and Clinical Significance in Patients with Left Ventricular Hypertrophy

Background: Little is known regarding the tissue Doppler characteristics and clinical significance of mitral annular motion during diastasis (L' wave). Methods: In consecutive patients with left ventricular hypertrophy and normal ejection fraction, standard Doppler and Doppler tissue imaging were performed. Patients were followed up for heart failure (HF) hospitalization. Results: Of 177 patients, 53 (30%) had an L′, detected most frequently at the lateral mitral annulus, whereas 35 (20%) had middiastolic transmitral flow (L wave), which almost invariably coexisted with the L'. The L' predicted increased left ventricular filling pressure with 74% sensitivity and 82% specificity, and increased risk of future HF (hazard ratio 3.9 [P = .030]), even after adjusting for baseline clinical differences (hazard ratio 6.5 [P = .024]). When associated with an L wave, HF risk increased further. Conclusions: Middiastolic annular motion, detectable in almost a third of patients with left ventricular hypertrophy, may be an early marker of diastolic dysfunction and a prognostic marker for HF.