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(Circulation. 1999;99:E13.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Diastolic Mitral Regurgitation

Yoram Agmon, MD; William K. Freeman, MD; Jae K. Oh, MD; James B. Seward, MD

From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn.

Correspondence to Dr William K. Freeman, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

A67-year-old man underwent transthoracic echocardiography for the evaluation of heart failure. The echocardiographic examination demonstrated significant dilatation of all cardiac chambers with marked global left ventricular (LV) systolic dysfunction (LV ejection fraction of 10% to 15%). Color flow imaging revealed a mild-to-moderate degree of mitral regurgitation (MR). Diastolic as well as systolic MR was detected by multiple Doppler modalities (Figures 1 to 3). Diastolic MR resulted from the combination of first-degree atrioventricular (AV) block and severe elevation of LV filling pressures.

View larger version (62K): [in this window] [in a new window]   Figure 1. Pulsed-Doppler interrogation of mitral inflow from an apical transducer position. Fusion of mitral E and A waves is evident (arrow) as a result of combination of sinus tachycardia (heart rate of 100 bpm) and first-degree AV block (PR interval of 260 ms). Note that LV filling is extremely abbreviated, to 20% of total cardiac cycle length. Fused mitral inflow pattern does not allow evaluation of LV diastolic function. Doppler interrogation of pulmonary venous flow (not shown) was consistent with restrictive LV filling dynamics (low systolic and high diastolic velocities).

View larger version (47K): [in this window] [in a new window]   Figure 2. Color M-mode recording of flow through mitral valve from an apical transducer position. MR (encoded in blue) is clearly evident during majority of cardiac cycle, including second half of diastole (arrow) as well as systole. Fused earlier mitral inflow, corresponding to pulsed-Doppler inflow signal in Figure 1, is encoded in red (arrowhead).

View larger version (170K): [in this window] [in a new window]   Figure 3. Continuous-wave Doppler recording of transmitral flow from an apical transducer position. A lower-velocity signal of diastolic MR (arrow) precedes systolic . . . [Full Text of this Article]

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