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Additional Value of Pulmonary Vein Parameters in Defining Pseudonormalization of Mitral Inflow Pattern
Author(s) -
Rossi Andrea,
Loredana Latina,
Cicoira Mariantonietta,
Bonapace Stefano,
Zanolla Luisa,
Zardini Piero,
Golia Giorgio
Publication year - 2001
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1046/j.1540-8175.2001.00673.x
Subject(s) - preload , cardiology , medicine , pulmonary vein , mitral regurgitation , diastole , ejection fraction , mitral valve , heart failure , hemodynamics , atrial fibrillation , blood pressure
Background: An echocardiographic assessment of left ventricular (LV) diastolic dysfunction is still challenging when identifying a pseudonormal mitral pattern (PSE) in an unselected population. The present study analyzed and compared the accuracy of various parameters in correctly identifying a PSE pattern in patients with a broad range of ejection fraction (EF) and degree of mitral regurgitation. Methods: Eighty‐two patients with E/A ≥ 1 and an invasive determination of left ventricular end‐diastolic pressure (LVEDP) were enrolled in the study. Mitral E wave (E max ) and A (A max ) velocities, E (DTe) and A (DTa) deceleration times, pulmonary vein systolic and diastolic velocities, and time velocity integrals were measured. The different duration between mitral and pulmonary vein A wave (A′‐A) also was calculated. E max and E/A during Valsalva maneuver were measured and expressed as percentage compared with baseline. LV end‐diastolic (LVD), end‐systolic (LVS), and EF were measured from the apical four‐chambers view (area‐length method). Left atrial end‐systolic (LA max ) and end‐diastolic (LA min ) were measured from the apical four‐ and two‐chambers views (area‐length method). Left atrial filling volume (LA fill ) was the difference between LA max and LA min . Mitral regurgitant volume was estimated by the following equation: MR vol = 6.18 + (1.01 * LA fill − (0.783 * PVs % ). Results: Thirty‐two patients (age: 55 ± 21 years; 75% male) had LVEDP ≤ 18 mmHg and were classified as normal mitral pattern (Group 1). Fifty patients (age: 57 ± 22 years; 76% male) had LVEDP > 18 mmHg, and were classified accordingly as having PSE (Group 2). At logistic univariate analysis, DTa (0.005), LV EF (0.01), A′‐A (<0.0001) and % E/A (0.03) were the more powerful predictors of PSE. A′‐A had the highest global accuracy in identifying PSE in patients with reduced (90%) and normal (88%) LV EF. Conclusion: A′‐A has the highest accuracy in identifying PSE in an unselected population. This parameters should be implemented in routine echocardiography since it allows additional information about LV diastolic function assessment.