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Doppler‐Derived Left Ventricular Negative dP/dt as a Predictor of Atrial Fibrillation or Ischemic Stroke in Patients with Degenerative Mitral Regurgitation and Normal Ejection Fraction
Author(s) -
Yi JeongEun,
Lee DongHyeon,
Cho Eun Joo,
Jeon HuiKyung,
Jung HaeOk,
Youn HoJoong
Publication year - 2014
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12350
Subject(s) - cardiology , medicine , atrial fibrillation , ejection fraction , mitral regurgitation , stroke (engine) , regurgitation (circulation) , heart failure , mechanical engineering , engineering
The aim of this study was to investigate the role of Doppler‐derived left ventricular (LV) −dP/dt in predicting atrial fibrillation (AF) or ischemic stroke in patients with moderate to severe degenerative mitral regurgitation (MR). Methods Doppler‐derived LV −dP/dt was determined from the continuous‐wave Doppler spectrum of the MR jet (−dP/dt = 32/time between 3 and 1 m/sec) in 80 patients (mean age 59 ± 16 years, 41% men) with moderate to severe degenerative MR, normal LV ejection fraction (LVEF ≥ 60%), and sinus rhythm at diagnosis. Events were defined as new AF or ischemic stroke. Results During a mean follow‐up of 18 ± 13 months, there were 9 events (6 new AF, 3 ischemic strokes). Univariate analysis showed that older age, decreased LV −dP/dt, increased LV mass index, and left atrial volume index (LAVI), shortened deceleration time (DT), reduced A′ velocity, and elevated E/E′ ratio, prolongation of pulmonary venous (PV) atrial reversal (AR) flow duration relative to mitral inflow A‐wave duration (AR‐Adur) were associated with events. In multivariate Cox regression analysis, Doppler‐derived LV −dP/dt (for each 100 mmHg/sec increase, hazard ratio: 0.165, 95% confidence interval: 0.036–0.761, P = 0.021) and E/E′ (hazard ratio: 0.820, 95% confidence interval: 0.682–0.987, P = 0.036) were significant independent predictors of AF or ischemic stroke. Conclusions Doppler‐derived LV −dP/dt is independently associated with the occurrence of AF or ischemic stroke in patients with moderate to severe degenerative MR and provides additional prognostic information.