‘Abnormal’ diastolic Doppler patterns in patients over age 65 with severe left ventricular systolic dysfunction

Objective: The purpose of this study was to determine whether Doppler diastolic filling patterns of the left ventricle are altered in patients over age 65 with poor left ventricular function, compared to patients with normal left ventricular systolic function. Background: In elderly, healthy subjects, the mitral valve Doppler inflow pattern exhibits an increase in atrial contribution to left ventricular filling. Myocardial disease, which results in stiffness, may also cause an increase in A wave velocity. Methods: Twenty-seven patients over age 65, with left ventricular systolic dysfunction, were age and sex-matched with 19 patients with normal left ventricular systolic function. Patients with significant mitral or aortic valvular disease were excluded. Maximal early inflow velocity, maximal atrial inflow velocity, heart rate, acceleration time and deceleration time were calculated. Results: Comparing the group with normal left ventricular systolic function, the group with decreased left ventricular systolic function had pseudonormalization of the maximal early flow/atrial flow velocity ratio (1.7 ± 1.3 vs. 0.9 ± 0.3; P = 0.003), E wave velocity was similar (82 ± 28 vs. 70 ± 24 cm/s; P = n.s.), and A wave velocity was diminished (66 ± 30 vs. 84 ± 20 cm/s; P = 0.02). The acceleration time was similar for the groups (53 ± 17 vs. 46 ± 21 ms), but the deceleration time was shorter in patients with left ventricular systolic dysfunction (122 ± 33 vs. 192 ± 80 ms; P < 0.001). Conclusion: Such differences may relate to increased left atrial pressure, increased left ventricular diastolic pressure and/or decreased atrial systolic function. These findings are important when interpreting left ventricular filling indices by Doppler echocardiography in elderly patients.