Influence of Doppler sample volume location on the assessment of changes in mitral inflow velocity profiles.
Previous studies that have validated Doppler indexes of mitral inflow have used pulsed wave sample volume locations either at the level of the mitral valve anulus or at the tips of the mitral valve leaflets. Although significant differences between absolute values for peak velocities and velocity time integrals at these sample volume locations have previously been reported, no information exists that has compared changes in inflow profiles after an intervention to improve left ventricular filling. To address this question, 13 patients with severe pulmonary hypertension (mean pulmonary artery pressure, 50 +/- 13 mm Hg) caused by chronic thromboembolic disease were studied with use of Doppler echocardiography immediately before and after surgical reduction of pulmonary hypertension (pulmonary vascular resistance decreased from 916 +/- 413 to 233 +/- 89 dynes.sec.cm5). This clinical model has been shown to have abnormal mitral inflow velocity profiles that improve markedly after surgery. Doppler measures of early and late peak velocities were significantly lower both before and after surgery when sampling at the mitral anulus compared with the leaflet tips, although late filling parameters and the deceleration of early flow velocity tended to differ little. With surgery, the significant increase in peak early velocity and the ratio of early to late velocity was present regardless of the sample volume location (peak E at leaflet tips, 47.1 +/- 16.0 to 68.9 +/- 15.4 [p less than 0.001], and at anulus, 40.7 +/- 11.3 to 56.2 +/- 14.6 cm/sec [p less than 0.001]; peak E/A at leaflet tips, 0.95 +/- 0.4 to 1.55 +/- 0.9, and at anulus, 0.78 +/- 0.3 to 1.32 +/- 0.7 [both p less than 0.02]).(ABSTRACT TRUNCATED AT 250 WORDS)
Dittrich
H C
HC
Adult Cardiac Noninvasive Laboratory, University of California, San Diego.
Blanchard
D G
DG
Wheeler
K A
KA
McCann
H A
HA
Donaghey
L B
LB
D001783:Blood Flow Velocity / Q000502:physiology; D003326:Coronary Circulation / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000601:surgery; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000601:surgery; D016277:Ventricular Function, Left / Q000502:physiology