Relation of left ventricular filling paterns to ratio of pulmonary venous to mitral a velocity in patients with left ventricular systololic dysfunction

In the present study, we retrospectively evaluated the ratio of pulmonary venous to mitral A velocity (PV-A/A) in patients with left ventricular (LV) systolic dysfunction with three specific types of LV filling patterns. Method:Transthoracic and transesophageal echocardiography were performed in 44 patients with LV systolic dysfunction in sinus rhythm, aged 20 to 73 years (mean 54±12), and in 11 control subjects without cardiovascular disease aged 24 to 69 years (mean 53±7). Patients were divided into three groups according to LV filling pattern: Group I; those with an impaired relaxation filling pattern (E wave/A wave <1, n=16), group II; those with a pseudonormal filling pattern (1< E/A<2 , n=12) and group III; those with a restrictive filling pattern (E/A> 2, n=16). Results: The control group and the three patient groups were not different with respect to age, gender and heart rate. All patient groups showed significantly lower LV ejection fraction than the control group, and was lowest in group III. The mitral peak A wave velocity was significantly lower in group III than in the first, control and second groups (p<0.001, p<0.01and p<0.05, respectively) and was highest in group I. The pulmonary A wave velocity did not differ among groups I, III and the controls, and was higher in group II than in the controls (p<0.01). The PV-A/A ratio was significantly 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 the controls and group I, but were lower compared to the group II (p<0.05). Conclusion: An increased ratio of PV-A/A was noted in subjects with LV systolic dysfunction with restrictive and pseudonormal LV filling patterns. This supports the idea that the PV-A/A ratio reflects LV filling pressures.