Document Detail

Assessment of mitral inflow during standardized Valsalva maneuver in stratification of diastolic function.
MedLine Citation:
PMID:  17456064     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: We assessed the changes of mitral inflow during Valsalva maneuver (VM) in patients with different stages of left ventricular dysfunction and evaluated their value for the differentiation between normal and pseudonormal filling pattern. METHODS: A total of 190 patients (120 with coronary artery disease, and 70 healthy subjects) were examined by transthoracic echocardiography. Mitral E/A ratio, early wave deceleration time (Edt), and pulmonary vein flow (especially atrial reversal parameters (Ar)), were used for the initial stratification to normal, delayed relaxation, pseudonormal, and restrictive profiles. Changes of mitral inflow during VM were compared between 54 normal (N) and 15 pseudonormal (PN). RESULTS: During VM, a similar decrease in early wave peak velocity (-30 +/- 18 vs -35 +/- 17 cm/sec), peak velocity of atrial wave (-6 +/- 16 vs -8 +/- 17 cm/sec), and E/A ratio (-0.4 +/- 0.4 vs -0.4 +/- 0.4) was observed in both groups. Only two filling variables, related to atrial phase of inflow, changed in the opposite direction. In normal pattern, the duration and velocity-time integral of atrial wave diminished during VM as opposed to pseudonormal subjects (DeltaAt -7 +/- 39 vs 20 +/- 44 msec; P < 0.05 and DeltaA vti -0.7+/-1.8 vs 0.4+/-2 cm; P < 0.05). Increase in peak atrial velocity and marked decrease in E/A ratio during VM were specific for the restrictive group. CONCLUSIONS: Changes of mitral inflow during VM have a moderate diagnostic value for the differentiation of normal and pseudonormal pattern. Increased duration of atrial phase but not increase in atrial velocity allowed the diagnosis of pseudonormalization.
Karina Wierzbowska-Drabik; Jaroslaw Drozdz; Michal Plewka; Malgorzata Kurpesa; Maria Krzemińska-Pakula; Jaroslaw D Kasprzak
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Echocardiography (Mount Kisco, N.Y.)     Volume:  24     ISSN:  0742-2822     ISO Abbreviation:  Echocardiography     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-25     Completed Date:  2007-08-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8511187     Medline TA:  Echocardiography     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-71     Citation Subset:  IM    
II Chair and Department of Cardiology, Medical University of Lodz, Lodz, Poland.
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MeSH Terms
Analysis of Variance
Blood Flow Velocity
Case-Control Studies
Coronary Artery Disease / physiopathology,  ultrasonography
Echocardiography, Doppler, Pulsed
Heart Atria / physiopathology,  ultrasonography
Middle Aged
Mitral Valve / physiopathology*,  ultrasonography*
Observer Variation
Pulmonary Veins / physiopathology,  ultrasonography
Reproducibility of Results
Research Design
Sensitivity and Specificity
Stroke Volume
Valsalva Maneuver*
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography*
Ventricular Function, Left*

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