Mitral Annular Displacement

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The systolic excursion of the mitral annulus can be displayed as a loop of serial echocardiographic frames. The motion can be used to assess function of the interventricular septum in patients with paradoxic septal motion due to left bundle branch block. This helps distinguish true hypokinesis from altered septal motion purely due to the conduction abnormality.


  1. Alam M, Rosenhamer G. Atrioventricular plane displacement and left ventricular function. J Am Soc Echocardiogr 1992;5:427-33.
  2. Alam M, Hoglund C, Thorstrand C, Hellekant C. Haemodynamic significance of the atrioventricular plane displacement in patients with coronary artery disease. Eur Heart J 1992;13:194-200.
  3. Alam M. The atrioventricular plane displacement as a means of evaluating left ventricular systolic function in acute myocardial infarction. Clin Cardiol 1991;14:588-94.
  4. Alam M, Hoglund C, Thorstrand C, Philip A. Atrioventricular plane displacement in severe congestive heart failure following dilated cardiomyopathy or myocardial infarction. J Intern Med 1990;228:569-75.
  5. Hoglund C, Alam M, Thorstrand C. Atrioventricular valve plane displacement in healthy persons. An echocardiographic study. Acta Med Scand 1988;224:557-62.
  6. Hoglund C, Alam M, Thorstrand C. Effects of acute myocardial infarction on the displacement of the atrioventricular plane: an echocardiographic study. J Intern Med 1989;226:251-6.
  7. Pai RG, Bodenheimer MM, Pai SM, Koss JH, Adamick RD. Usefulness of systolic excursion of the mitral anulus as an index of left ventricular systolic function. Am J Cardiol 1991;67:222-4.
  8. Silva JA, Khuri B, Barbee W, Fontenot D, Cheirif J. Systolic excursion of the mitral annulus to assess septal function in paradoxic septal motion. Am Heart J 1996; 131: 138-45.

Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, Lee MM, Park YB, Choi YS, Seo JD, Lee YW. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 1997 Aug;30(2):474-80

OBJECTIVES: This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function. BACKGROUND: Mitral inflow velocity recorded by Doppler echocardiography has been widely used to evaluate left ventricular diastolic function but is affected by other factors. The mitral annulus velocity profile during diastole may provide additional information about left ventricular diastolic function. METHODS: Mitral annulus velocity during diastole was measured by Doppler tissue imaging (DTI) 1) in 59 normal volunteers (group 1); 2) in 20 patients with a relaxation abnormality as assessed by Doppler mitral inflow variables (group 2) at baseline and after saline loading; 3) in 11 patients (group 3) with normal diastolic function before and after intravenous nitroglycerin infusion; and 4) in 38 consecutive patients (group 4) undergoing cardiac catheterization in whom mitral inflow velocity and tau as well as mitral annulus velocity were measured simultaneously. RESULTS: In group 1, mean +/- SD peak early and late diastolic mitral annulus velocity was 10.0 +/- 1.3 and 9.5 +/- 1.5 cm/s, respectively. In group 2, mitral inflow velocity profile changed toward the pseudonormalization pattern with saline loading (deceleration time 311 +/- 84 ms before to 216 +/- 40 ms after intervention, p < 0.001), whereas peak early diastolic mitral annulus velocity did not change significantly (5.3 +/- 1.2 cm/s to 5.7 +/- 1.4 cm/s, p = NS). In group 3, despite a significant change in mitral inflow velocity profile after nitroglycerin, peak early diastolic mitral annulus velocity did not change significantly (9.5 +/- 2.2 cm/s to 9.2 +/- 1.7 cm/s, p = NS). In group 4, peak early diastolic mitral annulus velocity (r = -0.56, p < 0.01) and the early/late ratio (r = -0.46, p < 0.01) correlated with tau. When the combination of normal mitral inflow variables with prolonged tau (> or = 50 ms) was classified as pseudonormalization, peak early diastolic mitral annulus velocity < 8.5 cm/s and the early/late ratio < 1 could identify the pseudonormalization with a sensitivity of 88% and specificity of 67%. CONCLUSIONS: Mitral annulus velocity determined by DTI is a relatively preload-independent variable in evaluating diastolic function.

Mitral inflow Doppler with corresponding mitral annulus tissue Doppler below, in the following four diastolic left ventricular filling conditions: normal, abnormal relaxation, pseudonormal and restrictive.

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