Left ventricular long-axis changes in early diastole and systole: impact of systolic function on diastole

Impaired long-axis motion is a sensitive marker of systolic myocardial dysfunction, but no data are available that relate long-axis changes in systole with those in diastole, particularly in subjects with diastolic dysfunction and a ‘normal’ left ventricular (LV) ejection fraction. A total of 311 subjects (including 105 normal healthy volunteers) aged 20-89 years with variable degrees of systolic function (LV ejection fraction range 0.15-0.84) and diastolic function were studied using tissue Doppler echocardiography and M-mode echocardiography to determine mean mitral annular amplitude and peak velocity in systole and early and late diastole. The LV systolic mitral annular amplitude (S_LAX, where LAX is long-axis amplitude) and peak velocity (S_m) correlated well with the respective early diastolic components (E_LAX and E_m) and late diastolic (atrial) components (A_LAX and A_m). A non-linear equation fitted better than a linear relationship (non-linear model: S_LAX against E_LAX, r² = 0.67; S_m against E_m, r² = 0.60; S_LAX against A_LAX and S_m against A_m, r² = 0.42). After adjusting for age, sex and heart rate, linear relationships of early diastolic (E_LAX, r² = 0.70; E_m, r² = 0.60) and late diastolic (A_LAX, r² = 0.61; A_m, r² = 0.64) long-axis amplitudes and velocities with the respective values for S_LAX and S_m were found, even in those subjects with apparently ‘isolated’ diastolic dysfunction. Long-axis changes in systole or diastole did not correlate with Doppler mitral velocities. We conclude that ventricular long-axis changes in early diastole are closely related to systolic function, even in subjects with diastolic dysfunction. ‘Pure’ or isolated diastolic dysfunction is uncommon.