title: Clinical relevance of the low correlations between Doppler and hemodynamic measurements before and after balloon mitral commissurotomy.
abstract: The aim of this study was to evaluate the clinical consequences of the poor correlations between Doppler and hemodynamic measurements before and after balloon mitral commissurotomy (BMC). From March 1987 to December 1991, 317 patients with symptomatic mitral stenosis were selected for BMC at the Montreal Heart Institute. Despite the low correlation coefficients between Doppler and hemodynamic measurements before BMC (transmitral gradient: r = 0.57, mitral valve area: r = 0.35, mitral regurgitation: r = 0.33), the positive predictive value of Doppler echocardiography to select patients for BMC was 96%. Hemodynamic success, defined as a final mitral valve area greater than 1.5 cm2 and an increase in mitral valve area of more than 25% was obtained in 204 (80%) of the 253 patients who completed the procedure without complications. Doppler and hemodynamic mitral valve area increase were poorly correlated (r = 0.2) but the sensitivity and specificity of Doppler in the diagnosis of hemodynamic success were 86% and 63% respectively. A prospective six month echocardiography and hemodynamic re-examination was performed in our 50 patients first treated by BMC. Hemodynamic restenosis, defined as a loss of more than 50% of the gain achieved in mitral valve area and a mitral valve area of less than 1.5cm2 were diagnosed in 12 (26%) of the 46 patients with initially successful BMC. Despite a low correlation between Doppler and hemodynamic mitral valve area measurements (r = 0.28), the sensitivity and specificity of echocardiography in the diagnosis of hemodynamic restenosis were 66% and 88% respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Montreal Heart Institute, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Le Feuvre
authors.forename: M L
authors.initials: ML
authors.lastname: Lachuriè
authors.forename: L A
authors.initials: LA
authors.lastname: Mercier
authors.forename: J
authors.initials: J
authors.lastname: Lespèrance
authors.forename: I
authors.initials: I
authors.lastname: Dyrda
authors.forename: J
authors.initials: J
authors.lastname: Crèpeau
authors.forename: R
authors.initials: R
authors.lastname: Bonan
mesh_terms: D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D002404:Catheterization; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome