Peak Mitral Inflow Velocity Research Articles

Left Ventricular Function in Children and Adolescents With Type 1 Diabetes Mellitus

Background and ObjectivesAdult studies have reported that patients with diabetes mellitus (DM) show ultrastructural and functional myocardial deterioration. The aim of this study was to assess whether cardiac functional deterioration can be detected in pediatric patients with type I DM and whether or not a relatively short duration of DM and hyperglycemia influences cardiac function.Subjects and MethodsForty-seven children and adolescents with DM and 38 healthy subjects (control group) were enrolled. Glycosylated hemoglobin (HbA1c), DM-induced complications, and left ventricular (LV) function as assessed using conventional and unconventional echocardiography {tissue Doppler imaging (TDI) and vector velocity imaging (VVI)} were evaluated.ResultsThe conventional echocardiographic parameters, with the exception of early peak mitral inflow velocity, the findings of pulsed wave TDI at the annular level, and regional ventricular function by VVI, were not significantly different between the two groups. Using the conventional and unconventional indices of systolic and diastolic function, no significant relationship was found between the duration of DM and the echocardiographic parameters. The deceleration time (DT) and E'/A' had an inverse correlation with HbA1c (p=0.042 and p=0.016, respectively).ConclusionPatients with DM in childhood and early adolescence rarely have insight on the significance of DM, and their diet is difficult to control. An alteration of myocardial function induced by DM may begin earlier than generally thought, and these changes are accelerated when glycemic control is poor. We recommend the early institution of close observation of patients with diabetes for alterations in cardiac function, in addition to other diabetic complications.

Echocardiographic Evaluation of Diastolic Function Can Be Used to Guide Clinical Care

For normal cardiac performance, the left ventricle (LV) must be able to eject an adequate stroke volume at arterial pressure (systolic function) and fill without requiring an elevated left atrial (LA) pressure (diastolic function). These systolic and diastolic functions must be adequate to meet the needs of the body both at rest and during stress. Response by Tschope and Paulus on p 809 Systolic function is conveniently (although not always accurately) measured as the ejection fraction (EF), calculated as stroke volume divided by end-diastolic volume.1 The LV EF is easily interpreted. The lower limit of normal is ≈50%. The lower the EF is, the greater the reduction in systolic function. Diastolic function has been more difficult to evaluate.2 Traditionally, invasive measures of LV diastolic pressure-volume relations and the rate of LV pressure fall during isovolumetric relaxation have been used. However, these methods are not practical for routine clinical use and do not adequately evaluate all aspects of diastolic filling.3 Comprehensive echocardiographic evaluation of the dynamics of LV filling using blood pool and tissue Doppler has now progressed so that it provides clinically important information that can be used to direct patient care. We present data that support the use of echocardiographic evaluation of diastolic function to recognize cardiac dysfunction in patients with heart failure, especially those with preserved EF; to guide the management of patients by identifying those with and without elevated left filling pressures regardless of underlying EF; and to determine prognosis in a wide variety of patient populations. Although the LV end-diastolic pressure-volume relation describes the passive properties of the LV, LV filling is not a passive or slow process.3 In fact, the peak flow rate across the mitral valve is equal to or greater than the peak flow rate across the aortic valve. …

Prevalence of Left Ventricular Diastolic Dysfunction in a General Population

Because the process of myocardial remodelling starts before the onset of symptoms, recent heart failure (HF) guidelines place special emphasis on the detection of subclinical left ventricular (LV) systolic and diastolic dysfunction and the timely identification of risk factors for HF. Our goal was to describe the prevalence and determinants (risk factors) of LV diastolic dysfunction in a general population and to compare the amino terminal probrain natriuretic peptide level across groups with and without diastolic dysfunction. In a randomly recruited population sample (n=539; 50.5% women; mean age, 52.5 years), we measured early and late diastolic peak velocities of mitral inflow (E and A), pulmonary vein flow by pulsed-wave Doppler, and the mitral annular velocities (Ea and Aa) at 4 sites by tissue Doppler imaging. A healthy subsample of 239 subjects (mean age, 43.7 years) provided age-specific cutoff limits for normal E/A and E/Ea ratios and the differences in duration between the mitral A and the reverse pulmonary vein flows during atrial systole (DeltaAd-ARd). The number of subjects in diastolic dysfunction groups 1 (impaired relaxation), 2 (elevated LV end-diastolic filling pressure), and 3 (elevated E/Ea and abnormally low E/A) were 53 (9.8%), 76 (14.1%), and 18 (3.4%), respectively. We used Delta(Ad<ARd+10) to confirm possible elevation of LV filling pressures in group 2. Compared with subjects with normal diastolic function (n=392, 72.7%), group 1 (209 versus 251 pmol/L; P=0.015) and group 2 (209 versus 275 pmol/L; P=0.0003) but not group 3 (209 versus 224 pmol/L; P=0.65) had a significantly higher adjusted NT-probrain natriuretic peptide. Higher age, body mass index, heart rate, systolic blood pressure, serum insulin, and creatinine were significantly associated with a higher risk of LV diastolic dysfunction. The overall prevalence of LV diastolic dysfunction in a random sample of a general population, as estimated from echocardiographic measurements, was as high as 27.3%.

Comparison of Magnetic Resonance Imaging Versus Doppler Echocardiography for the Evaluation of Left Ventricular Diastolic Function in Patients With Cardiac Amyloidosis

To assess the role of magnetic resonance imaging (MRI) in the assessment of diastolic function, diastolic mitral inflow parameters using MRI and transthoracic Doppler echocardiography (echocardiography) were compared in patients with cardiac amyloidosis. Thirty-eight patients (age 60 +/- 12 years; 32% women) in sinus rhythm with cardiac amyloidosis (biopsy-proven systemic amyloidosis and positive echocardiographic and contrast-enhanced cardiac MRI findings) were evaluated. Cine phase-contrast MRI images of mitral inflow were obtained in the left ventricle to quantify diastolic blood flow. MRI measurements of diastolic parameters were compared (Spearman's rank correlation) with echocardiographic diastolic mitral inflow velocity parameters. Additional analysis was performed comparing MRI findings in patients with a restrictive echocardiographic diastolic filling pattern (n = 23) versus those without (n = 15). For the 38 patients, early diastolic (E) peak velocity was 61 +/- 26 cm/s using MRI versus 79 +/- 21 using echocardiography (Spearman's rank correlation 0.55, p = 0.0004), and late diastolic (A) peak velocity was 46 +/- 22 cm/s using MRI versus 47 +/- 22 cm/s using echocardiography (Spearman's rank correlation 0.54, p = 0.0005). E/A ratio was 1.55 +/- 0.9 using MRI and 2.25 +/- 1.4 using echocardiography (Spearman's rank correlation 0.75, p <0.0001). Deceleration times in both modalities showed good correlation (MRI, 180 +/- 44 ms vs echocardiography, 179 +/- 49; Spearman's rank correlation 0.61, p = 0.0001). MRI E/A ratio for peak velocities was significantly higher in patients with restrictive echocardiographic patterns (1.95 +/- 1.0) versus those without (0.93 +/- 0.3; p = 0.0003). Two of 23 patients with a restrictive echocardiographic pattern had an MRI E/A ratio <1. In conclusion, mitral inflow peak velocities, deceleration times, and E/A ratios detected using phase-contrast MRI in patients with cardiac amyloidosis showed moderately good correlation with echocardiography and identified most patients with restrictive echocardiographic patterns.

Mitral regurgitation – evaluation of a multidimensional echocardiographic grading system. A study on 177 patients with chronic primary and secondary mitral regurgitation

Introduction.In grading mitral regurgitation (MR) magnetic resonance imaging is the gold standard but 2D echo is mostly used in clinical practice. However, each single echo parameter is prone to confounding influences. With regard to chronic primary and secondary MR the purpose of this study was to compare a new multi-dimensional echo-based grading system with an independent pre-operatively used invasive standard. Methods. In a retrospective study we analyzed 177 patients with different degrees of MR severity, who were examined both by echocardiography and by cardiac catheterization. For MR grading a combination of four echocardiographic parameters was used: density of the regurgitation velocity profile, peak mitral inflow velocity (Vmax E-wave), radius of the proximal flow convergence zone (PISA), and vena contracta (Vc) width. Invasive grading was based on left ventriculography (Seller's method), V wave hight, and regurgitation fraction. Both methods resulted in an integrative score on an eight point scale (<I-IV in half-steps). Echocardiographic and invasive data were correlated. Results. There was a reasonable overall correlation of r = 0.72 (p = 0.001) between both grading systems. Echo tended to slightly overestimate MR severity. In patients with secondary MR, agreement was worse (p = 0.01) than in primary MR. The most powerful single echo parameter was Vc r = 0.71 (p = 0.001). Presence or absence of sinus rhythm had no significant influence on echo grading. Conclusions. The proposed echocardiographic multidimensional MR grading system is feasable and shows good correlation with invasive grading.

Usefulness of Tissue Doppler Parameters for Identifying Pulmonary Embolism in Patients With Signs of Pulmonary Hypertension

The objective of this study was to use tissue Doppler parameters to identify pulmonary embolism (PE) in patients with echocardiographic signs of pulmonary hypertension. One hundred fifty patients with echocardiographic signs of pulmonary hypertension were enrolled, 50 of whom had PE on multidetector row computed tomography of the chest. Another 150 patients without cardiopulmonary distress or echocardiographic signs of pulmonary hypertension served as a control group. All patients were in sinus rhythm. Routine echocardiography and tissue Doppler imaging were performed. The right ventricular (RV) myocardial performance index (MPI) was obtained during tissue Doppler imaging over the lateral tricuspid annulus. The M index was measured and defined as the peak early diastolic mitral inflow velocity divided by the RV MPI. Statistical analysis was preformed using receiver-operating characteristic curves. Peak early diastolic mitral inflow velocity was significantly less and the RV MPI was significantly greater in patients with PE than in patients without PE (both p values < 0.0001). The RV MPI and the M index were useful in identifying PE in patients with echocardiographic signs of pulmonary hypertension. On statistical analysis, a RV MPI > 0.55 identified PE with a sensitivity of 85% and a specificity of 78%. A M index < 112 had a sensitivity of 92% and a specificity of 92%. In conclusion, the sensitivity and specificity of the RV MPI and the M index to identify PE were excellent. Echocardiography is a useful method to screen for PE.

1112 Estimation of end diastolic pressure with early mitral inflow peak velocity to early diastolic myocardial motion peak velocity ratio is limited in patients with severely impaired active relaxation

1112 Estimation of end diastolic pressure with early mitral inflow peak velocity to early diastolic myocardial motion peak velocity ratio is limited in patients with severely impaired active relaxation

Doppler echocardiography flow-velocity image analysis for patients with atrial fibrillation

Currently, Doppler echocardiography analysis is performed manually. An automated method that analyzes the Doppler signal can potentially improve accuracy and result in a powerful tool for noninvasive evaluation of cardiac hemodynamics, especially for patients with atrial fibrillation, where multiple samples are needed to obtain an accurate averaged measurement. The aim of this study was to develop an automated method for Doppler analysis based on image processing and computer vision algorithms. Images were obtained from the mitral valve and the tricuspid valve Doppler tracings from 45 patients, 20 with normal sinus rhythm and 25 with atrial fibrillation. The proposed algorithm automatically detects the maximal velocity envelope of the spectral Doppler ultrasound tracings. Averaged values for the time velocity integral, peak mitral inflow velocity and peak tricuspid regurgitation velocity were calculated for multiple beats available in a single screen frame. Measurements extracted automatically from the maximal velocity envelope were compared to measurements obtained manually by two expert technicians. High linear correlation (r) was found between the automatically- and the manually-extracted parameters (0.95 < r < 0.99). A smaller variation was found in most cases between the manually-calculated average beat and the automated average beat (bias value between 3.8% and 5.2%) than between the manually-calculated average beat and the selection of a representative beat (bias value between 6.2% and −2.6%). The newly-developed automated method offers a new, accurate and reliable clinical tool, particularly for the assessment of patients with irregular heart rate. (E-mail: hayit@eng.tau.ac.il)

Surgical Coronary Revascularization with or without Mitral Valve Repair of Severe Ischemic Dilated Cardiomyopathy

Because patients with dilated cardiomyopathy tend to have a poor prognosis with medical therapy, surgery with coronary bypass alone or associated with mitral valve repair should be a promising feasible therapeutic option. We evaluated the early effects of surgical coronary revascularization with or without mitral valve repair in patients with severe dilated ischemic cardiomyopathy. The study group consisted of 38 patients aged 65 +/- 8 years with severe dilated ischemic cardiomyopathy, chest pain, and heart failure. Twenty-four patients were in a New York Heart Association (NYHA) class > or =3, and 14 patients were in class 2. Twenty patients had a degree of mitral regurgitation defined as an effective regurgitant orifice > or =20 mm2. The mean values (+/-SD) of the EuroSCORE, which evaluates operative risk, were 5 +/- 2.2. Clinical and echocardiographic reevaluation followed at 6 months. All patients underwent coronary artery bypass surgery with a mean of 2.3 +/- 0.8 grafts, and mitral valve repair with annuloplasty and Cosgrove ring insertion were performed in 20 patients. No deaths occurred during the operative period. Ten patients could not be reevaluated at 6 months, and 3 patients died (7.9% mortality). At 6 months, the end-systolic volumes in 15 patients who underwent coronary bypass plus mitral valve repair (group A) and in 13 patients who underwent coronary bypass alone (group B) decreased, respectively, from 139 +/- 56 mL to 121 +/- 94 mL and from 122 +/- 48 mL to 96 +/- 36 mL (P < .05). The wall motion score index also decreased from 1.9 +/- 0.3 to 1.4 +/- 0.4 and from 2.1 +/- 0.3 to 1.8 +/- 0.2, respectively. The mean values of the ejection fraction, the peak early mitral inflow velocity, and the ratio of the peak early mitral inflow velocity to the peak late mitral inflow velocity increased significantly in both groups (P < .001, P < .01, and P < .05, respectively). The mean NYHA functional class significantly improved in both groups (P < .0001). In patients with severe ischemic dilated cardiomyopathy, surgical coronary revascularization can be safely carried out during the operative and early postoperative periods with low mortality rates. This procedure decreased left ventricular end-systolic volume, consistently increased contractility, and subsequently ameliorated the ejection fraction to produce improvements in clinical condition according to the NYHA functional class. Similar results have been obtained in patients who have undergone coronary bypass surgery and mitral valve repair, despite a higher operative risk and longer cardiopulmonary bypass circulation and aortic cross-clamping times.

Mitral valve leaflet excursion velocity in the pediatric population: A comparable diastolic index to the color M-mode propagation velocity

Color M-mode (CMM) Doppler flow propagation velocity (Vp) is a reliable diastolic index, but may be difficult to define. We hypothesized that because the valve is opened by flow, the anterior mitral leaflet excursion velocity (MEVApex ), interrogated from the cardiac apex, may be similar to the CMM-Vp. We investigated the MEVApex by apical M-mode echocardiography in 49 children and adolescents with normal echocardiograms, and compared it with the CMM-Vp and other indices. The mean CMM-Vp and MEVApex were similar (41.5 +/- 6 vs 40 +/- 5.7, respectively, mean +/- SD; P = .5) and correlated positively ( r = 0.71, P < .0001, Bland-Altman analysis). The peak velocity of mitral inflow (E wave) divided by the Vp (E/Vp) and E/MEVApex correlated well (2.54 +/- 0.58 vs 2.52 +/- 0.58, respectively, mean +/- SD; r = 0.857, P < .001, Bland-Altman analysis). The MEVApex is comparable with the CMM-Vp and the E/MEVApex with E/Vp. The Vp may be assessed either by CMM or conventional M-mode from the apex. In our experience, the latter is easier to do. Study in other populations is warranted.

Dipyridamole-induced abnormal Tl-201 lung uptake in patients with normal myocardial perfusion: a marker of increased left ventricular filling pressures

Background The mechanism of dipyridamole-induced abnormal increased T1-201 lung uptake in patients without coronary artery disease is poorly understood. The purpose of this study was to evaluate the relation between dipyridamole-induced abnormal T1-201 lung uptake and left ventricular (LV) diastolic indexes using Doppler, color M-mode and Tissue Doppler modalities at rest, and at dipyridamole stress echocardiograpy (DSE) in patients with normal myocardial perfusion and LV function. Methods and results 18 consecutive patients (mean age 64 ± 7 years) with normal myocardial perfusion and increased lung T1-201 uptake on dipyridamole stress-redistribution single photon emission computed tomography (SPECT) were included in our study. These patients were compared with 18 age-matched control patients with normal perfusion and normal T1-201 lung uptake. All patients underwent DSE. A good correlation was found between the T-201 lung uptake, the peak early velocity of mitral inflow (E, r = 0.57) and estimated pulmonary capillary wedge pressure (PCWP = 1.24[E/Ea] + 1.9, r = 0.68). In patients with increased L/H ratio compared to control group, the E and the PCWP were significantly higher at baseline 81 ± 18 vs 68 ± 11 (cm/s) and 13 ± 3 vs 10.2 ± 2 (mmHg). An additional significant increase of E to 91 ± 23 (cm/s ( P = 0.001)) and PCWP to 14.8 ± 3 ( P = 0.005) after dipyridamole administration was seen; in contrast to a nonsignificant change observed in control group. For the detection of a dipyridamole induced PCWP >12 mmHg, a L/H ratio of ≥50% had a sensitivity of 72% and a specificity of 83%, resulting in a positive and a negative predictive value of 81% and 75%, respectively. Conclusions A dipyridamole-induced abnormal T1-201 lung uptake in patients with normal myocardial perfusion and systolic function is predictive of elevated filling pressures at rest and in response to dipyridamole administration, probably reflecting an intrinsic resting diastolic dysfunction and a further abnormal response to vasodilatation.

A new device for beating heart bipolar radiofrequency atrial ablation

Objective A technique for mimicking left atrial atriotomies using an ablation device that can be deployed without cardiopulmonary bypass has been developed. Methods In 12 healthy large (35-50 kg) adult pigs, maze-like ablation lesions were directly applied to the left atrial epicardium on the beating heart. The ablation device is irrigated, with a bipolar “hemostat” morphology, utilizing radiofrequency energy. Prior to and after ablation, left atrial electromechanical properties were measured during sinus rhythm in the latest 5 pigs using percutaneous endocardial catheter electromechanical mapping and intracardiac echocardiography. Pathologic analysis was performed acutely. Results All ablation lesions demonstrated conduction block along their entire course. Global left atrial conduction time (49.4 ± 8.8 milliseconds before vs 58.8 ± 9 milliseconds after) and pattern were not significantly altered. Although a significant amount (17.12% ± 9%) of myocardium was either ablated or electrically isolated, ablation was not associated with significant alterations in global left atrial mechanics (left atrium ejection fraction 19% before vs 17% after; pulmonary vein peak flow velocity 1.22 m/s before vs 1.38 m/s after; peak mitral inflow velocity 2.34 m/s before vs 2.64 m/s after), mitral valve function, nor left ventricular function. There was no evidence of atrial thrombus formation. Transmurality was achieved in most lesions with no evidence of charring or barotrauma. Conclusions Utilizing this ablation device, atrial lesions similar to the left component of the Maze procedure were deployed with uniform success in a beating heart without cardiopulmonary bypass or atriotomy and without adverse effects on left atrial electromechanics.

Diagnostic value of mitral annular velocity for constrictive pericarditis in the absence of respiratory variation in mitral inflow velocity

Respiratory variation of 25% or more in transmitral early diastolic filling (E) velocity is a well-recognized diagnostic feature of constrictive pericarditis (CP) that is useful for distinguishing it from restrictive cardiomyopathy. However, a subset of patients with CP do not exhibit the typical respiratory change. Recent data showed that mitral annular (E′) velocity measured by Doppler tissue echocardiography (DTE) is markedly reduced in patients with restrictive cardiomyopathy whereas E′ velocity is well-preserved in CP. This study evaluated the role of DTE for the diagnosis of CP when there is no characteristic respiratory variation of E velocity. From September 1999 to March 2001, 19 patients (17 men, 2 women; mean age, 57 ± 13 years) with surgically confirmed CP underwent comprehensive echocardiography preoperatively, including pulsed wave and DTE examination with simultaneous recording of respiration. Nine (47%) of the 19 patients had less than 25% respiratory variation in E velocity. There was no significant difference in mitral inflow peak velocity, deceleration time, early-to-late ventricular filling ratio, and E′ velocity between patients with and patients without respiratory variation of E velocity of 25% or more. Regardless of the presence or absence of a significant respiratory variation of E velocity, E′ velocity was relatively normal (mean, 12 ± 4 cm/s) in all patients with CP. In conclusion, E′ velocity is well preserved in patients with isolated CP even when there is no characteristic respiratory variation of E velocity. Thus, when the respiratory variation in Doppler E velocity is blunted or absent during the evaluation of suspected CP in patients with restrictive mitral inflow velocity, preserved E′ velocity shown by DTE should support the diagnosis of CP over a primary myocardial disease. (J Am Soc Echocardiogr 2002;15:1468-71.)

Apport de l’échocardiographie Doppler dans le diagnostic de l’insuffisance cardiaque aiguë à fonction systolique conservée du sujet âgé

Purpose: To evaluate the clinical usefulness of the determination of Doppler mitral inflow pattern and new combined indices using colour M mode velocity flow propagation (Vp) in the diagnosis of acute diastolic heart failure in the elderly. Methods: Total serum protein concentration (P, g/l) and E/A, E/Vp and 1000/(2 × IRT + Vp) Doppler indices (E and A: mitral inflow peak velocities ; IRT : isovolumic relaxation time) were measured at the time of therapy initiation in 94 patients with left ventricular ejection fraction > 50% (78 ± 13 years), 56 with pulmonary edema and 38 patients with acute respiratory disease. Results: The feasibility was 73, 90 and 89% for E/A, E/Vp and 1000/(2 × IRT + Vp) respectively. The sensitivity, specificity and accuracy were 94–56–72%, 84–86–85% and 92–86–89% for E/A ≥ 1, E/Vp ≥ 2 and 1000/(2 × IRT + Vp) ≥ 6 respectively in the diagnosis of pulmonary edema in patients with normal serum colloid osmotic pressure defined by P ≥ 60g/l, and 41–50–43%, 37–86–50% and 22–100–42% in patients with low colloid osmotic pressure ( P < 60g/l). Conclusions: The mitral inflow measurement is limited in most of cases of acute diastolic heart failure in the elderly by confounding factors such as atrial fibrillation and normalised pattern. New combined Doppler indices are useful in these patients, however, their value must be interpreted according to the serum colloid osmotic status estimated by total serum protein concentration.

Usefulness of peak mitral inflow velocity to predict severe mitral regurgitation in patients with normal or impaired left ventricular systolic function

Background The aim of this study was to evaluate the reliability of peak mitral inflow (E-wave) velocity, which was thought to be easier and more practical than qualitative and quantitative methods used to grade mitral regurgitation (MR) in patients both with normal and low left ventricular (LV) ejection fraction (EF). It is known that peak E-wave velocity increases in MR. But correlation of this increase with regurgitant fraction (RF), its usefulness in grading MR, and the effect of EF on peak E-wave velocity have not been studied in detail. Methods We prospectively examined 135 consecutive patients with varying grades of MR with echocardiography. MR was evaluated both qualitatively and quantitatively, and concordance of these 2 methods was determined. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. LV isovolumetric relaxation and contraction times were measured. Different MR groups classified by RF were compared with each other. Results Concordance of quantitative and qualitative evaluation was low in patients with low EF (κ 0.37 vs 0.65). Peak E-wave velocity and E/A ratio showed significant differences between MR groups. Peak E-wave velocity correlated with the RF and EF (r = 0.47, r = 0.33, respectively, P < .001). Sensitivity, specificity, and negative predictive value of peak E-wave velocity >1.2 m/s suggesting severe MR were found to be different in patients with normal and low EF (96% vs 66%, 78% vs 83%, 97% vs 78%, respectively). E-wave deceleration, LV isovolumetric relaxation, and contraction time did not show a correlation with RF. Conclusion Peak E-wave velocity is a screening method that could be used in common for determining severity of MR semiquantitatively, especially in patients with normal EF. (Am Heart J 2001;142:1065-71.)

Mitral Annulus Velocity in the Evaluation of Left Ventricular Diastolic Function in Atrial Fibrillation

This study assessed the clinical utility of mitral annulus velocity in the evaluation of left ventricular diastolic function in patients with atrial fibrillation. Atrial fibrillation is the most common sustained arrhythmia encountered in clinical practice. The clinical usefulness of conventional Doppler indexes is limited in atrial fibrillation because of the altered left atrial pressure and loss of synchronized atrial contraction. Mitral inflow and mitral annulus velocities were measured simultaneously with tau in 27 patients with nonrheumatic atrial fibrillation at the cardiac catheterization laboratory. Among deceleration time of mitral inflow, peak mitral inflow velocity (E), and peak diastolic mitral annulus velocity (E ́), only E ́ correlated with tau ( r = 0.51, P = .007). Prolonged tau (≥50 ms) could be predicted by E ́ <8 cm/s with a sensitivity of 73% (16 of 22) and a specificity of 100% (5 of 5). The E/E ́ ratio correlated with left ventricular filling pressure ( r = 0.79, P < .001). The E/E ́ ratio of ≥11 could predict elevated left ventricular filling pressure (≥15 mm Hg) with a sensitivity of 75% (9 of 12) and a specificity of 93% (14 of 15). Mitral annulus velocity is useful in the detection of impaired left ventricular relaxation and estimation of filling pressure even in patients with atrial fibrillation. (J Am Soc Echocardiogr 1999;12:927-31.)

Usefulness of transthoracic echocardiography in detecting significant prosthetic mitral valve regurgitation

To identify the transthoracic echo-Doppler (TTE) variables most predictive of significant mitral regurgitation (MR) of mechanical prosthetic valves, TTE and transesophageal echo (TEE) studies were independently reviewed in 57 patients (mean age [± SD] 59 ± 12.5 years) undergoing both studies within 2 ± 3 days. Several 2-dimensional and Doppler hemodynamic variables from the TTE studies were derived. Prosthetic MR was significant (moderate or severe) by TEE in 20 patients, whereas mild or no MR was seen in 37 patients. The best univariate predictors of significant MR by TTE were peak velocity of mitral inflow, mean gradient, tricuspid regurgitation velocity, isovolumic relaxation time, and ratio of time velocity integral of mitral inflow to time velocity integral in the left ventricular outflow (TVI MV/TVI LVO). Peak mitral velocity and TVI MV/TVI LVO were the best predictors of significant MR and performed similarly (area under the receiver-operating characteristic curve: 0.97 for both). A peak velocity of ≥1.9 m/s was 90% sensitive and 89% specific for significant prosthetic MR, whereas a TVI MV/TVI LVO ≥2.5 had a sensitivity and specificity of 89% and 91%, respectively. A decision tree was constructed to assess the conditional probabilities of having significant MR given all the possible outcomes of the 2 best predictors. None of the patients with peak velocity <1.9 m/s and TVI MV/TVI LVO <2.5 by TTE had significant MR. Conversely, all patients with peak velocity ≥1.9 m/s and TVI MV/TVI LVO ≥2.5 had significant MR. The use of more complex algorithms did not further improve the results. Thus, measurements of hemodynamic Doppler variables on TTE examination can accurately identify a large number of patients without significant prosthetic MR, thereby reducing the need for further investigation with TEE.

Resting diastolic function and left ventricular mass are related to exercise capacity in hypertensive men but not in women

We evaluated the impact of diastolic function and gender on exercise capacity in sedentary, untreated hypertensive subjects (34 men, 23 women) using echocardiography and a bicycle ergometry with measurement of oxygen consumption (VO 2). In men, peak (A) mitral inflow velocity and left ventricular (LV) mass were inversely related to peak VO 2 (r = −0.64) and maximal workload (r = −0.57) and were the sole independent determinants of exercise capacity. In women, there was no relationship between any echocardiographic measure and exercise capacity. Thus, LV mass and Doppler-determined diastolic function predict maximal VO 2 in hypertensive men but not in women. This finding may be related to gender differences in the contribution of diastolic filling to exercise capacity or may reflect limitations of resting Doppler echocardiography to predict exercise diastolic filling in hypertensive women.

Peak Mitral Inflow Velocity and jet Width of the Vena Contracta as Simple Predictors of Mitral Regurgitation Severity

Peak Mitral Inflow Velocity and jet Width of the Vena Contracta as Simple Predictors of Mitral Regurgitation Severity

Peak mitral inflow velocity and jet width of the vena contracta as simple predictors of mitral regurgitation severity

Peak mitral inflow velocity and jet width of the vena contracta as simple predictors of mitral regurgitation severity