Evaluation Of Left Ventricular Diastolic Function By Flow Propagation Velocity Of Under The Mitral Valve Using Dual Doppler Echocardiography

Objective:The flow propagation velocity?v_p?of under the mitral valve in early left ventricular diastolic period was detected by dual pulsed wave Doppler?PW?,and dual Doppler echocardiography was compared with M-mode color Doppler by evaluating left ventricular diastolic function of normal subjects and patients.Methods:A total of 128 patients of outpatient and inpatient in The People's Liberation Army Joint Service Support Force No.967 Hospital from March 2019 to September 2019 were selected.According to the inclusion criteria and exclusion criteria,78 patients were excluded.Finally,a total of 50 patients were included in the study.There were 30 males and 20 females.In addition,24 healthy volunteers were included as the control group,including 14 males and 10 females.We collected clinical parameters including gender,age,blood pressure,blood glucose,coronary artery disease and clinical history.We also collected ultrasonic parameters including early diastolic velocity by the side of mitral annulus spacing?e'?,the early-diastolic peak velocity of the transmitral flow?E?,the late-diastolic peak velocity?A?,E/A ratio,left atrial systolic diameter,interventricular septum,left ventricular posterior wall,left ventricular diastolic long diameter and left ventricular long diameter,left ventricular diastolic short diameter and left ventricular systolic short diameter.Value of v_pmeasured by dual Doppler echocardiography(v_{p PW}):from the apical four-chamber view,the first sample volume was placed at the mitral valve?D1?.Another sampling volume was placed at 4cm?S?from the mitral valve to the apex of the heart?D2?.The anterior transmitral flow spectrum was recorded synchronously at both sites.According to the synchronous electrocardiogram,the time difference??T?at the beginning edges of the two spectrums at D1 and D2 is measured during the same cardiac period.Calculation of the value of v_p(v_{p PW})according to V?v_p?=S/?T.Value of v_p(v_{p M})measured by M-mode color Doppler:in the M-mode color Doppler mode,M-mode color Doppler images of left ventricular diastole period were displayed on the apical four-chamber view.We measured the slopes of the isovelocity lines.The difference and correlation of dual PW Doppler,M-mode color Doppler and other related indexes in the patient group and control group were compared.The reproducibility between interobserver and intraobserver was compared.The measurement reproducibility of dual PW and M-mode color Doppler was compared by Med Calc.Results:1.Comparisons of general dataSystolic blood pressure,diastolic blood pressure,heart rate and fasting blood glucose in the patient group were significantly higher than those in the control group?P<0.05?,but there was no significant difference between the two groups in age and gender?P>0.05?.2.Comparisons of conventional parameters of echocardiographyIn the patient group,interventricular septum,left ventricular posterior wall,left ventricular diastolic long diameter,left ventricular systolic long diameter,left ventricular diastolic short diameter,left atrial systolic diameter and A were significantly higher than those in the control group,e'was significantly lower than that in the control group?P<0.05?,while there was no significant difference between the two groups in E,E/A and left ventricular systolic short diameter?P>0.05?.3.Comparisons of v_{p PW}and v_{p M}In the patient group,v_{p PW}and v_{p M}were significantly lower than those in the control group?P<0.05?.Within the patient group,there were significant differences in v_{p PW}and v_{p M}?P<0.05?;Within the control group,there were significant differences in v_{p PW}and v_{p M}?P<0.05?.In all subjects,v_{p PW}was significantly related to v_{p M}?r=0.905,P< 0.05?,v_{p PW}was moderately related to e'?r=0.465,P<0.05?,and v_{p M}was moderately related to e'?r=0.488,P<0.05?.4.The reproducibility of v_pbetween interobserver and intraobserverICCs of Dual PW intraobserver?0.94?and interobserver?0.85?are better than ICCs of M-mode color Doppler intraobserver?0.81?and interobserver?0.71??P<0.05?.5.Comparison of measurement reproducibility between dual PW and M-mode color DopplerThe analysis of Bland-Altman showed that the difference of v_pbetween M-mode color Doppler and dual PW about 96%was in the 95%limits of agreement.Conclusion:Dual PW Doppler can replace M-mode color Doppler.And dual PW Doppler can better evaluate left ventricular diastolic function than M-mode color Doppler.