Evaluation of mitral regurgitation by pulmonary venous blood flow patterns. Relation to angiographic and haemodynamic parameters in subgroups of patients.
OBJECTIVE
To study the relationship between pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transesophageal echocardiography and angiographic grading and haemodynamic parameters in subgroups of patients with mitral regurgitation.


BACKGROUND
Reversed systolic pulmonary venous flow is a sensitive sign of severe mitral regurgitation. Scarse data are available regarding the effects of atrial fibrillation and coronary artery disease.


METHODS
PVSFfr was calculated as the systolic flow velocity integral divided by the total inflow integral. PVSFfr is negative when systolic flow is dominantly reversed. 111 patients were studied.


RESULTS
PVSFfr < 0 was 91% sensitive for angiographic severe mitral regurgitation (MR) (specificity 75%). In patients with sinus rhythm and without coronary artery disease the sensitivity was 100% and specificity was 86% (n = 25). PVSFfr correlated to angiographic grade (r = -0.63, P = 0.0001), mean PCW (r = -0.63, P = 0.0001), v-wave (r = -0.72, P = 0.0001), systolic blood pressure (r = 0.28, P = 0.003) and left atrial diameter (r = -0.42, P = 0.0001) (n = 111). Stepwise linear regression analysis revealed the v-wave, angiographic grading, left atrial diameter and systolic blood pressure to be independent predictors of PVSFfr. Subgroup analysis revealed a correlation (r = 0.85, n = 25) between angiographic grading and PVSFfr in patients with sinus rhythm without CAD and (r = 0.35, n = 23) in patients with CAD in atrial fibrillation.


CONCLUSIONS
PVSFfr is valuable in assessing mitral regurgitation. In the presence of atrial fibrillation and coronary artery disease the correlation with angiographic grading decreases indicating the dynamic nature of this valvular lesion.
Department of Clinical Physiology, University of Hospital of Northern Sweden, Umeå, Sweden.
D
D
Teien
S
S
Holm
K
K
Karp
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000502:physiology*; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D014655:Vascular Resistance