title: Invasive assessment of mitral regurgitation: comparison of hemodynamic parameters.
abstract: OBJECTIVE
  We sought to analyze several new hemodynamic characteristics which address the interplay of left atrial (LA) and left ventricular (LV) pressures, as well as to re-analyze several other V wave characteristics employed in the determination of mitral regurgitation (MR) severity in order to determine which, if any, had adequate correlation with grade of MR for clinical utility.
  
  
  BACKGROUND
  Invasive assessment of mitral regurgitation includes analysis of intracardiac pressures and LV angiography. The V wave, when obtained from the pulmonary capillary wedge position (PCWP), and its various characteristics are believed to be of limited value for prediction of MR severity.
  
  
  METHODS
  We analyzed the transeptal pressure tracings of patients with various degrees of MR. Several relationships from the simultaneous pressure-time curves of the LA and LV were defined. Biplane left ventricular angiography was used to grade MR. Correlation between each parameter and MR grade was determined by calculating a Pearson correlation coefficient.
  
  
  RESULTS
  The ratio of the area under the V wave to the LV systolic area (V(a)/LV(a)) best correlates with the degree of MR with a Pearson correlation coefficient of 0.60. The V(a)/LV(a) was significantly lower in patients with 0-1+ MR compared to > or =2+ MR (0.14 vs. 0.23 p = 0.002).
  
  
  CONCLUSIONS
  Invasive hemodynamic assessment of MR severity could be enhanced by calculating our new ratio, V(a)/LV(a), due to its ability to account for LV work that is lost to the LA with a proportional decrease in forward or useful LV work with progressively increasing severity of MR.
authors.affiliation: Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois 60153, USA. jfreih@lumc.edu
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Freihage
authors.forename: Dominique
authors.initials: D
authors.lastname: Joyal
authors.forename: Dinesh
authors.initials: D
authors.lastname: Arab
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dieter
authors.forename: Henry S
authors.initials: HS
authors.lastname: Loeb
authors.forename: Lowell
authors.initials: L
authors.lastname: Steen
authors.forename: Bruce
authors.initials: B
authors.lastname: Lewis
authors.forename: Jayson C
authors.initials: JC
authors.lastname: Liu
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Leya
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011669:Pulmonary Wedge Pressure; D012720:Severity of Illness Index