Hemodynamic assessment of mitral stenosis: mitral valve resistance as an echocardiographic index.
OBJECTIVE
Although mitral valve (MV) resistance has been proposed as a new index for the determination of hemodynamic consequence in patients with mitral stenosis (MS), the relationship between this resistance and signs of hemodynamic deterioration, such as the elevation of pulmonary artery pressure and plasma levels of brain natriuretic peptide (BNP), has not yet been investigated.


METHODS
The study population comprised 33 consecutive patients (nine males, 24 females; mean age 39 +/- 6 years) with moderate and severe MS (MV area (MVA) <1.5 cm2). The cause of MS in all patients was rheumatic valvular disease. A comprehensive echocardiographic evaluation was performed, with MVA, mean MV pressure gradient (MVPG), systolic pulmonary artery pressure (sPAP) and mitral valve resistance being calculated for all patients, in addition to plasma BNP levels.


RESULTS
Both, plasma BNP level and sPAP correlated better with MV resistance (r = 0.75, p < 0.001 and r = 0.52, p = 0.002, respectively) than with MVA by pressure half-time method (MVA-PHT) (r = -0.68, p < 0.001 and r = -0.55, p = 0.001, respectively) and mean MVPG (r = 0.62, p < 0.001 and r = 0.69, p < 0.001, respectively). A comparison of MV resistance and conventional stenotic indices showed that MV resistance correlated best with mean MVPG (r = 0.70, p < 0.001), and correlated least with MVA-PHT (r = -0.45, p = 0.009). Patients with sPAP >50 mmHg and plasma BNP level >150 pg/ml had a significantly higher MV resistance than patients with sPAP < 50 mmHg and plasma BNP level <150 pg/ml.


CONCLUSIONS
MV resistance appeared to be better correlated with elevated sPAP and plasma BNP levels than with conventional stenosis indices.
Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey. haliltanboga@yahoo.com
Ibrahim Halil
IH
Tanboga
Mustafa
M
Kurt
Mehmet
M
Ekinci
Turgay
T
Isik
Ahmet
A
Kaya
Emine
E
Bilen
Enbiya
E
Aksakal
D000328:Adult; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood
D020097:Natriuretic Peptide, Brain