Chronic mitral regurgitation and Doppler estimation of left ventricular filling pressures in patients with heart failure.
Previous studies relating Doppler parameters and pulmonary capillary wedge pressures (PCWP) typically exclude patients with severe mitral regurgitation (MR). We evaluated the effects of varying degrees of chronic MR on the Doppler estimation of PCWP. PCWP and mitral Doppler profiles were obtained in 88 patients (mean age 55 +/- 8 years) with severe left ventricular (LV) dysfunction (mean ejection fraction 23% +/- 5%). Patients were classified by severity of MR. Patients with severe MR had greater left atrial areas, LV end-diastolic volumes, and mean PCWPs and lower ejection fractions (each P <.01). In patients with mild MR, multiple echocardiographic parameters correlated with PCWP; however, with worsening MR, only deceleration time strongly related to PCWP. From stepwise multivariate analysis, deceleration time was the best independent predictor of PCWP overall, and it was the only predictor in patients with moderate or severe MR. Doppler-derived early mitral deceleration time reliably predicts PCWP in patients with severe LV dysfunction irrespective of degree of MR.
Temporelli
P L
PL
Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Medical Center of Rehabilitation, Via Revislate, 13, 28010 Veruno (NO), Italy.
Scapellato
F
F
Corrà
U
U
Eleuteri
E
E
Firstenberg
M S
MS
Thomas
J D
JD
Giannuzzi
P
P
D002908:Chronic Disease; D015150:Echocardiography, Doppler; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology; D017725:Ventricular Pressure