Abstract 12859: Tissue Doppler Derived Biphasic Velocities During the Pre and Post-Ejection Phases: Patterns, Concordance and Hemodynamic Significance in Health and Disease

Abstract

Introduction: Pre-(PRE) and post-ejection (POE) velocities by mitral annular tissue Doppler (TD) are biphasic and may be related to myocardial deformations. We investigated the predominance and concordance of TD-PRE and POE velocities and their effect on myocardial functions in controls and in HF patients. Methods: Retrospectively, 84 HF patients [57.6±8 years, 28(33%) females, NYHA: 2.3±0.6, EF: 55±15%, 52(62%) preserved EF, and 32(38%) reduced EF], 42 normal young controls [27±4 years, 5(12%) females], and 26 asymptomatic age matched controls without cardiac abnormalities [53±12 years, 28(65%) females] were included. Results: While controls had almost always predominantly positive PRE and negative POE, HF had more negative PRE (Controls: 2%, HFpEF: 10%, HFrEF: 35%, p<0.001) and positive POE (Controls: 4%, HFpEF: 33%, HFrEF: 74%, p<0.001). Moreover, almost all controls exhibited normal concordance (positive PRE and negative POE). HF exhibited more abnormal concordance (Figure 1A,C) which was significantly associated with worse NYHA, and parameters of diastolic and systolic functions. Opposite PRE and POE velocities correlated significantly in all groups (PREp vs POEn: young:r=0.52, p<0.001, age controls:r=0.79, p<0.001, HFpEF: r=0.56, p<0.001, HFrEF: r=0.42, p=0.018; PREn vs POEp: young: r=0.25,p=0.1, age controls: r=0.42, p=0.04, HFpEF: r=0.43, p=0.004, HFrEF: r=0.61, p<0.001) and the ratios PRE-P/N and POE-N/P correlated significantly with E/e’ in HF only (Figure 1B). Conclusions: In physiological state, TD signals are predominantly positive during PRE and negative during POE. Opposite PRE and POE velocities corelate, representing the PRE-generation and POE-reversal of shortening-stretch relationships, the attenuation of which in HF may be related to elevated LV filling pressures. In HF, partially or completely reversed concordance of PRE and POE is associated with progressive worsening of clinical and hemodynamic profiles.