Relation of Left Ventricular Filling Paterns to The Ratio of Pulmonary Venous to Mitral A Velocity in Patients with Left Ventricular Systolic Dysfunction

Abstract

Objective: In the present study, we retrospectivelyevaluated the ratio of pulmonary venous to mitral Avelocity (PV-A/A) in patients with left ventricular (LV)systolic dysfunction with three specific types of LVfilling patterns.Method:Transthoracic and transesophagealechocardiography were performed in 44 patients withLV systolic dysfunction in sinus rhythm, aged 20 to 73years (mean 54±12), and in 11 control subjects withoutcardiovascular disease aged 24 to 69 years (mean53±7). Patients were divided into three groupsaccording to LV filling pattern: Group I; those with animpaired relaxation filling pattern (E wave/A wave <1,n=16), group II; those with a pseudonormal fillingpattern (1< E/A<2 , n=12) and group III; those with arestrictive filling pattern (E/A> 2, n=16).Results: The control group and the three patient groupswere not different with respect to age, gender and heartrate. All patient groups showed significantly lower LVejection fraction than the control group, and was lowestin group III. The mitral peak A wave velocity wassignificantly lower in group III than in the first, controland second groups (p<0.001, p<0.01and p<0.05,respectively) and was highest in group I. Thepulmonary A wave velocity did not differ among groupsI, III and the controls, and was higher in group II thanin the controls (p<0.01). The PV-A/A ratio wassignificantly higher in group III than in the control,groups I and II (p<0.001, p<0.001and p<0.05,respectively). The ratio did not differ between thecontrols and group I, but were lower compared to thegroup II (p<0.05).Conclusion: An increased ratio of PV-A/A was notedin subjects with LV systolic dysfunction with restrictiveand pseudonormal LV filling patterns. This supportsthe idea that the PV-A/A ratio reflects LV fillingpressures.Key words: Ventricular filling patern to mitral A velocity,ventricular systolic dysfunction