Quantitation of mitral regurgitation using the systolic/diastolic pulmonary venous flow velocity ratio.

Abstract

The purpose of this study was to test the hypothesis that pulmonary venous flow velocity ratios during systole and diastole in patients with mitral regurgitation (MR) correctly predict the quantitative degree of MR. Pulmonary venous flow velocity measurements have thus far been used only for the qualitative assessment of MR. Recent studies have evaluated this method using transesophageal echocardiography against semiquantitative references. In 100 patients without aortic regurgitation or atrial fibrillation and with left ventricular (LV) ejection fraction >45%, MR was assessed by quantitative echocardiographic Doppler and color Doppler, providing forward and total LV stroke volume for the calculation of the mitral regurgitant fraction (RFstandard), the reference parameter, and also supplying mitral regurgitant orifice area (ROA) values and the RF by the flow convergence method (RFPISA [proximal isovelocity surface area]). Measurements of pulmonary venous flow velocity time integral values during systole to diastole (VTIs/VTId) were obtained and tested for their predictibility of ROA, RFstandard and RFPISA. There was an inverse and significant correlation between VTIs/VTId and ROA, RFPISA and RFstandard, respectively: RFstandard=49 - 20 VTIs/VTId, r=0.77, p=0.0001. A principal source of variability in the relation between VTIs/VTId and RFstandard was the presence of mitral valve prolapse as the cause of MR. Pulmonary venous flow reversal (VTIs/VTId <0) correctly identified severe MR with 52% sensitivity, 96% specificity and 80% positive and 87% negative predictive accuracy. The VTIs/VTId ratio allows a moderately accurate assessment of the severity of MR.