Open Access Highly Accessed Research article

The relationship between mitral annular systolic velocity and ejection fraction in patients with preserved global systolic function of the left ventricle

Ivaylo Rilkov Daskalov1*, Ivona Kirilova Daskalova2, Lilia Davidkova Demirevska1 and Borislav Georgiev Atzev3

Author Affiliations

1 Department of Cardiology and Intensive Care, Cardiology Clinic, Military Medical Academy, 3 Georgi Sofiiski Blvd, Sofia 1606, Bulgaria

2 Department of Endocrinology and Metabolic Disorders, Endocrinology, Military Medical Academy, 3 Georgi Sofiiski Blvd, Sofia 1606, Bulgaria

3 Department of Cardiology, University Hospital “St.Ekaterina”, 52A Pencho Slaveikov Blvd, Sofia 1000, Bulgaria

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BMC Cardiovascular Disorders 2013, 13:92  doi:10.1186/1471-2261-13-92

Published: 26 October 2013



The aim of the study was to investigate the relationship between the ejection fraction (EF) and the mitral annular systolic velocity (Sm) in patients with preserved left ventricular systolic function (EF>55%). The study task was to evaluate whether the assessment of Sm(avg) can be used as an alternative to the Simpson’s method in assessment of the EF. The expected benefit was that Sm could be used to predict EF, when EF is difficult to assess due to poor image quality (IQ).


Sm was obtained by spectral pulse wave Tissue Doppler Imaging (pwTDI) from the lateral and septal sites of the mitral annulus (MA) and an averaged value was calculated - Sm(avg). EF was assessed using Simpson’s rule. Participants were divided into controls (n=70), hypertensive (HTN, n=56), HTN with diastolic dysfunction (HTN/DD, n=65), HTN with diabetes mellitus (HTN/DM, n=52) and HTN with DD and DM (HTN/DD/DM, n=65).


Sm(avg) showed strong correlation with EF (r=0.978; p<0.0001). There were no significant differences between the correlation coefficients between the subgroups and the controls. The mathematical model that the study recommended to assess the EF is: EF=45.0 + 2 × Sm(avg).


The assessment of Sm(avg) could be used as an alternative to EF. This approach may be useful especially when the IQ is poor. The method maintains high accuracy and reproducibility in prediction of the EF.

Mitral annulus velocity; Ejection fraction; EF; Systolic function; Sm; TDI