Tissue Doppler-Derived Myocardial Acceleration during Isovolumetric Contraction Predicts Pulmonary Capillary Wedge Pressure in Patients with Significant Mitral Regurgitation

Abstract

The aim of this study was to determine whether isovolumic contraction velocity (IVV) and acceleration (IVA) predict pulmonary capillary wedge pressure (PCWP) in mitral regurgitation. Forty-four patients with mitral regurgitation were studied. PCWP was invasively measured. IVV, IVA and the ratio IVRT/Te′–E (where IVRT = isovolumic relaxation time, and Te′–E = time difference between the onset of mitral annular e′ and mitral flow E waves) were measured. Mean age was 59.2 ± 13.3 y. Twenty-six patients had an ejection fraction ≥55%, and 18 patients had an ejection fraction <55%. IVRT/Te′–E was impossible in 11 patients because Te′–E = zero. PCWP correlated with IVV, IVA and IVRT/Te′–E; overall (r = −0.714, −0.892 and, −0.752, all p < 0.001), ejection fraction ≥55 (r = −0.467, −0.749, −0.639, p = 0.016, <0.001, 0.003) and ejection fraction <55% (r = −0.761, −0.911 and −0.833, all p < 0.001). Similar correlations were found for sinus and atrial fibrillation. Our study suggests that IVV and IVA correlate with PCWP in patients with mitral regurgitation irrespective of systolic function or rhythms and, thus, can be alternatives to the tedious IVRT/Te′–E, especially when impossible because Te′–E = 0.