Aortic and Mitral Annuli Coupling and Its Association with Cardiac Function in Patients with Dilated Cardiomyopathy

Objective To compare the mitral and aortic annuli excursion (AE) and aortomitral angle (AMA) variations between patients with and without dilated cardiomyopathy (DCM) using speckle tracking echocardiography (STE), and determine the role of annuli dynamics and coupling behaviors in the left ventricular function. Methods Thirty-five patients with DCM and thirty-five age and sex matched healthy adults underwent transthoracic echocardiographic examinations. In the parasternal long-axis view, the AE and AMA variations were measured using Philips QLAB 9.0 software. In the apical four chamber view, the left ventricular ejection fraction (LVEF), longitudinal, circumferential, and radial strain were measured using Tomtec Arene 1.0 software. Results The DCM patients had significantly smaller AE and AMAmax-min, bigger AMAmax and AMAmin, and varied cardiac cycle compared with the healthy adults. The AMA of DCM patients increased to its maximal value earlier in diastole with little variation. AE was positively correlated with LVEF and multidirectional strain. AMAmax and AMAmin were negatively correlated with AE, LVEF and multidirectional strain (Pmax-min and AE, LVEF and multidirectional strain (P<0.05). Conclusion AE, AMA, LVEF and multidirectional strain can be quantified using STE. The coupling of mitral and aortic annuli in DCM patients is abnormal and correlated well with left ventricular systolic function. AE and AMA can be conveniently used for estimation of integral and regional cardiac function.