C  2007, the Authors Journal compilation C  2007, Blackwell Publishing, Inc. DOI: 10.1111/j.1540-8175.2007.00466.x Effect of Heart Rate on Tissue Doppler Measures of Diastolic Function Andrew T. Burns, M.B.B.S. (Hons)., ∗ Kim A. Connelly, M.B.B.S.,† Andre La Gerche, M.B.B.S., ∗ Donald J. Mooney, Grad Dip Appl Sci., ∗ Justin Chan, M.B.B.S., ∗ Andrew I. MacIsaac, M.D., ∗ † and David L. Prior, M.B.B.S., Ph.D. ∗ † ∗ Cardiac Investigation Unit and †University of Melbourne Department of Medicine, St. Vincent’s Hospital Melbourne, Victoria, Australia Background: Our aim was to study the independent effect of heart rate (HR) on parameters of diastolic function, particularly mitral annular velocities measured by tissue Doppler imaging (TDI), an effect which is not well understood. Methods: Sixteen patients with dual chamber pacemakers attending for routine pacemaker review underwent detailed echocardiographic assessment during atrial pacing with intact atrioventricular conduction at baseline and accelerated HRs. Mitral inflow and annular tissue Doppler velocities and systolic strain parameters were compared. Results: Parameters of systolic function were unaffected by increased HR. When these parameters were compared at baseline (mean 67 bpm) and accelerated HR (mean 80 bpm), the following was observed: a significant decrease in early mitral inflow (E) wave (70.5 ± 5.5 cm/s vs 63.5 ± 4.9 cm/s, P < 0.02) and early mitral annular (E ′ ) velocities (7.0 ± 0.5 cm/s vs 6.3 ± 0.6 cm/s, P < 0.003) and a significant increase in mitral inflow A wave (70.3 ± 4.5 cm/s vs 77.3 ± 4.4 cm/s, P < 0.05) and late mitral annular (A ′ ) velocities (9.3 ± 0.6 cm/s vs 10.8 ± 0.5, P < 0.00004). Conclusion: Changes in HR have previously unrecognized significant effects on tissue Doppler parameters of diastolic function. Further study is required to determine if tissue Doppler derived annular velocities should be corrected for HR. (ECHOCARDIOGRAPHY, Volume 24, August 2007) heart rate, diastole, echocardiography, tissue Doppler Abnormalities of diastolic function are rec- ognized as an important determinant of heart failure symptoms in the context of normal and abnormal systolic function. Isolated dias- tolic dysfunction is increasingly recognized as a significant cause of morbidity and mortality in our community. 1 Echocardiographic assess- ment of diastolic function is an important tool in the diagnosis and management of these pa- tients. Assessment of mitral inflow and pul- monary venous velocities is well established in the evaluation of diastolic function however pseudonormalization of mitral inflow velocities and preload dependence of both these measures Address for correspondence and reprint requests: Andrew T. Burns, M.B.B.S. (Hons), Cardiac Investigation Unit, St. Vincent’s Hospital, Melbourne, P.O. Box 2900, Fitzroy, Victoria, Australia, 3065. Fax: +61-3-9288-4423; E-mail: andrew.burns@svhm.org.au Dr. Andrew Burns is supported by a Postgraduate Medical Research Scholarship from the National Heart Foundation of Australia limits their utility in isolation. 2 Tissue Doppler imaging (TDI) has been an important advance in the assessment of diastolic function given its relative preload independence and repro- ducibility. 3 Heart rate (HR) can vary significantly be- tween assessments of an individual patient and between different patients and its independent effect on parameters of diastolic function is not well understood. Most studies to date looking at the effect of HR on diastolic function have compared different patients at baseline. 4–6 One study comparing individual patients at differ- ent rates of dual chamber pacing 7 found no dif- ference in TDI velocities however ventricular pacing itself may have significant effects on di- astolic function as can exercise and pharmaco- logic chronotropy. To our knowledge, the effect of HR, inde- pendent of changes in inotropic state, on mi- tral annular velocity assessed by TDI compar- ing the same human subjects at different HRs has not been examined. Therefore, we assessed Vol. 24, No. 7, 2007 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 697