Right ventricular contractile reserve in mitral stenosis: implications on hemodynamic burden and clinical outcome.
BACKGROUND
We investigated whether isovolumic acceleration (IVA) under inotropic stimulation as a means of right ventricular (RV) contractile reserve, is a surrogate for hemodynamic burden and has prognostic value in patients with mitral stenosis (MS).


METHODS
Thirty-one pure MS patients and 20 controls underwent cardiac catheterization, exercise test, and dobutamine stress echocardiography. RV fractional area change (FAC), +dP/dt/P(max), RV tissue Doppler indices (isovolumic contraction [IVC] and systolic [S] velocity, and IVA) were measured. Patients were followed-up for the occurrence of cardiac adverse events.


RESULTS
Inotropic modulation unmasked statistically significant differences regarding magnitude of changes in IVA, IVC, S, and +dP/dt/P(max), but not RV FAC. Inability to increase IVA more than 6.5 m/s(2) was the only independent determinant of pulmonary capillary wedge pressure >or=18 mm Hg (P=.004). Although MS severity did not predict the RV contractile reserve and pulmonary artery pressure (PAP) behavior during inotropic stimulation, the RV contractile reserve was related to the degree of systolic PAP. IVA increases of <3.4 m/s(2) had 86% sensitivity and 75% specificity to predict unfavorable outcomes during long-term follow-up (20+/-8 months).


CONCLUSIONS
RV contractile reserve provides complementary data to the hemodynamic significance of MS severity, may contribute to clinical decision making, and be of prognostic value in these patients.
Sade
Leyla Elif
LE
University of Başkent, Faculty of Medicine, Department of Cardiology, Ankara, Turkey. elifsade@baskent-ank.edu.tr
Ozin
Bülent
B
Ulus
Taner
T
Açikel
Sadik
S
Pirat
Bahar
B
Bilgi
Muhammed
M
Uluçam
Melek
M
Müderrisoğlu
Haldun
H
D000328:Adult; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D009200:Myocardial Contraction / Q000502:physiology*; D011379:Prognosis; D011669:Pulmonary Wedge Pressure; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology