| Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. | |
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MedLine Citation:
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PMID: 10073857 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Pulmonary venous flow (PVF) reversal is observed in mitral regurgitation (MR) and can be detected by Doppler echocardiography. However, the determinants of PVF alterations in MR have not been analyzed with simultaneous quantitative methods, and the diagnostic accuracy of flow reversal is uncertain. Prospectively, in 128 patients with isolated MR of various degrees (regurgitant fraction 4% to 81%), Doppler echocardiography was used to measure PVF velocity simultaneously to quantify MR by 2 methods and to perform a comprehensive hemodynamic assessment. Systolic PVF velocity was 4 +/- 56 cm/s (systolic flow reversal in 39 patients) and showed the strongest correlations with mitral effective regurgitant orifice (r = -0.56, p <0.0001). In multivariate analysis, larger effective regurgitant orifice (p <0.0001), eccentric jets (p = 0.0023), longer jets (p = 0.0033), and lower mitral regurgitant velocity (p = 0.0015) were independent determinants of decreased systolic PVF velocity. In organic MR, increased filling pressures were associated with systolic PVF reversal. Blunted systolic flow was associated with shorter mitral deceleration time (p <0.0001) and enlarged left atrium (p = 0.0007). For the diagnosis of severe MR (regurgitant orifice > or = 35 mm2, regurgitant fraction > or = 50%), systolic flow reversal sensitivity was 61% and 60%, and specificity was 92% and 85%, respectively. Among 29 patients in whom surgery demonstrated severe mitral lesions, 12 (41%) had no systolic flow reversal preoperatively. In patients with MR, the determinants of systolic PVF are complex and, in addition to the degree of MR, include the hemodynamic consequences of MR, jet characteristics, left ventricular filling, and left atrial volume alterations. Consequently, systolic PVF reversal is a useful sign of severe MR but of relatively low sensitivity, emphasizing the importance of quantifying MR. |
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Authors:
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M Enriquez-Sarano; K S Dujardin; C M Tribouilloy; J B Seward; A P Yoganathan; K R Bailey; A J Tajik |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 83 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1999 Feb |
Date Detail:
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Created Date: 1999-04-01 Completed Date: 1999-04-01 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 535-41 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Echocardiography, Doppler Female Hemodynamics Humans Male Middle Aged Mitral Valve Insufficiency / physiopathology*, ultrasonography Prospective Studies Pulmonary Veins / physiopathology* Regional Blood Flow Severity of Illness Index |
| Comments/Corrections | |
Comment In:
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Am J Cardiol. 1999 Jul 15;84(2):242
[PMID:
10426352
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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