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Patients With Alzheimer Disease Have Altered Transmitral Flow

Echocardiographic Analysis of the Vortex Formation Time

Translational Ultrasound Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona USA (M.B., P.J., A.M.C., E.M.M.); Longtine Center for Molecular Biology and Genetics (C.L.M., T.A.K., A.E.R.), Cleo Roberts Center for Clinical Research (L.J.V., M.N.S.), and Harold Civin Laboratory of Neuropathology (T.G.B.), Sun Health Research Institute, Sun City, Arizona USA; Department of Microbiology, Midwestern University, Glendale, Arizona USA (T.A.K.); Cardiovascular Department, Banner Boswell Medical Center, Sun City, Arizona USA (T.L.C.); and Methodist DeBakey Heart Center, Methodist Hospital, Texas Medical Center, Houston, Texas USA (Z.G.).

Address correspondence and reprint requests to Alex E. Roher MD, PhD, Sun Health Research Institute, 10515 W. Santa Fe Dr, Sun City, AZ 85351 USA., E-mail: alex.roher{at}bannerhealth.com

Objective. There is considerable epidemiologic evidence that Alzheimer disease (AD) is linked to cardiovascular risk factors and associated with an increased risk of symptomatic left ventricular (LV) dysfunction. Formation of a vortex alongside a diastolic jet signifies an efficient blood transport mechanism. The vortex formation time (VFT) is an index of optimal conditions for vortex formation. We hypothesized that AD and its associated cardiovascular risk factors impair diastolic transmitral flow efficiency and, therefore, shift the VFT value out of its optimal range. Methods. Echocardiographic studies were performed on 45 participants in total: 22 patients with AD diagnosed according to the American Psychiatric Association’s criteria and 23 age-matched individuals as a control group with cognitive function within normal limits. Results. The echocardiographic ratio of the early to atrial phases of the LV filling velocities was significantly lower in the AD group (mean ± SD, 0.67 ± 14) when compared with the control individuals (0.79 ± 0.14; P = .003). The interventricular septum diastolic thickness, left ventricular posterior wall diastolic thickness, and right ventricular end-diastolic diameter were significantly higher in the AD group (P 0.04). The mitral annular diameters in the control and AD groups were nearly identical (P = .725). The time-velocity integral of the E wave had a lower value in the AD group than in the control group (P = .05), whereas the VFT was significantly lower in the AD group (P = .018). Conclusions. Our study suggests that patients with AD have impaired transmitral flow efficiency of diastolic filling, as measured by the VFT, compared with age-matched control individuals.

Key Words: Alzheimer disease • blood flow velocity • diastolic function • vortex formation

Abbreviations: A, peak transmitral flow velocity during the late (atrial) filling phase • AD, Alzheimer disease • D, annular diameter of the mitral valve • E, peak transmitral flow velocity during the early filling phase • EF, ejection fraction • IVST, interventricular septum diastolic thickness • LAD, left atrial diameter • LV, left ventricular • LVDD, left ventricular end-diastolic diameter • LVEDV, left ventricular end-diastolic volume • LVESV, left ventricular end-systolic volume • LVPWT, left ventricular posterior wall diastolic thickness • LVSV, left ventricular stroke volume • MMSE, Mini Mental State Examination • MPI, myocardial performance index • ND, nondemented • RVDD, right ventricular end-diastolic diameter • TVI_E, time-velocity integral of the E wave • VFT, vortex formation time