The pseudonormal mitral profile is difficult to distinguish from a normal profile with echocardiography. Ever since a study showing that the Valsalva manoeuvre could unmask the appearance of relaxation disorders of transmitral flow (E/A < 1) in subjects with cardiopathy, this method has been proposed for the analysis of diastolic function. Very few data exist on the effect of this method in healthy subjects. The aim of this study was to evaluate the changes in mitral flow with this manoeuvre in middle aged healthy subjects, in order to establish the validity of this method for identifying the pseudonormal mitral profile. In 30 subjects (aged 50 +/- 5 years) we analysed mitral flow at rest and after the Valsalva manoeuvre, pulmonary venous flow, annular tissular Doppler, propagation velocity in colour TM and the combined indices (ENp, E/Ea). An inversion of the E/A ratio was obtained in 95% of subjects with an E/A ratio >1 (n=21, E/A=1.25 +/- 0.14) while all the other Doppler indices were in favour of normal flow. In conclusion, the inversion of mitral flow is very common in healthy subjects following the Valsalva manoeuvre. This observation underlines the limit of this method for distinguishing between a normal mitral profile and a pseudonormal profile. The optimal evaluation of diastolic function must rely on the various Doppler indices currently available especially for the detection of a developing cardiomyopathy.
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