Diastolic mitral annular motion in normal subjects and patients with coronary artery disease

The purpose of this study was to evaluate the characteristicsof mitral annular motion during diastole in 28 normal subjects,40 patients with prior myocardial infarction (MI), and 23 patientswith coronary artery disease but without prior MI. Mitral annularmotion during diastole was obtained from the apex by M-modeechocardiography at the posterior wall of the left ventricle.Determinants of mitral annular excursion during early (MAE-E)and late diastole (MAE-L) were investigated in all subjects.Differences in the MAE-E, MAE-L, and the MAE-L.MAE-E ratio werecompared among the three patient groups. The Doppler-derivedtransmitral flow velocity-time integral during early (El) andlate (AI) diastole and mitral annular excursions during diastolewere obtained in 55 other patients with a prior MI and in 29healthy volunteers. The relationships between the MAE-L: MAE-Eratio and AI: EI ratio in these two groups were studied. The MAE-E was determined mainly by heart rate and left ventricularejection fraction (LVEF). The MAE-L was determined only by age.The magnitude of MAE-E was significantly less in patients witha prior MI than in normal subjects (P<0.01). However, theMAE-L did not differ among the three groups. The MAE-L.MAE-Ewas higher in patients with a prior MI than in normal subjects(P<0.05), and was significantly correlated with AI: EI inhealthy volunteers (r=0.65, P<0.001) and in patients witha prior MI (r=0.50, P<0.001). The MAE-E in patients with a prior MI decreases in proportionto the deterioration in LVEF. The relative at rial contributionto left ventricular longitudinal distension is increased inpatients with a prior MI and diastolic mitral annular motionhas a significant relationship to the transmitral flow. Thesefindings suggest that mitral annular motion during late diastoleplays an important role in maintaining left ventricular fillingin patients whose left ventricular systolic function has deteriorated.