Document Detail


Hemodynamic and prognostic implications of net atrioventricular compliance in patients with mitral stenosis.
MedLine Citation:
PMID:  17928201     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: On the basis of the close association of left atrial compliance with pulmonary hypertension in patients with mitral stenosis, we hypothesized that: (1) Doppler-derived net atrioventricular compliance (C(n)) can be used for predicting the occurrence of mitral valve (MV) replacement or percutaneous mitral commissurotomy (PMC); and (2) determinants of exercise capacity are variable depending on C(n). METHODS: We consecutively enrolled 26 patients (22 women; mean age, 47.0 +/- 6.1 years; range, 35-59 years) with pure moderate or severe mitral stenosis, in whom comprehensive echocardiography was performed at rest. C(n) was derived from the equation that has been previously validated (ie, C(n) = 1270 x [MV area by 2-dimensional planimetry/mitral E-wave downslope]. Measurements of stroke volume and systolic pulmonary artery pressure were repeated immediately after symptom-limited treadmill exercise test within 60 seconds. RESULTS: On the basis of earlier reports, C(n) less than 4 mL/mm Hg was selected to define abnormally small C(n). During a mean duration of 24-month follow-up, C(n) of less than 4 mL/mm Hg could reliably predict the occurrence of either MV replacement or PMC, which was confirmed by multivariate logistic regression analysis. In patients with C(n) less than 4 mL/mm Hg, exercise duration was found to be closely correlated primarily with resting systolic pulmonary artery pressure (r = -0.73, P = .03), whereas in patients with C(n) greater than or equal to 4 mL/mm Hg, postexercise stroke volume was the only determinant of exercise capacity (r = 0.49, P = .04). When combining C(n) less than 4 mL/mm Hg with MV area less than 1.0 cm(2) as a cut-off value for predicting MV replacement or PMC, the sensitivity improved from 63.6% to 81.8% (P = .05). CONCLUSIONS: Left atrial compliance estimated by C(n) with Doppler echocardiography allows us to effectively predict the future occurrence of MV replacement or PMC, with a special usefulness in patients with moderate mitral stenosis. In addition, determinants of exercise capacity were variable depending on the degree of C(n).
Authors:
Hyung-Kwan Kim; Yong-Jin Kim; Seok-Jae Hwang; Jin-Shik Park; Hyuk-Jae Chang; Dae-Won Sohn; Byung-Hee Oh; Young-Bae Park
Publication Detail:
Type:  Journal Article     Date:  2007-10-10
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  21     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-05     Completed Date:  2008-06-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  482-6     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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MeSH Terms
Descriptor/Qualifier:
Adult
Atrioventricular Node / ultrasonography*
Echocardiography / methods*
Exercise Test
Female
Humans
Hypertension, Pulmonary / complications*,  ultrasonography*
Image Interpretation, Computer-Assisted / methods*
Male
Middle Aged
Mitral Valve Stenosis / complications*,  ultrasonography*
Prognosis
Reproducibility of Results
Risk Assessment / methods*
Risk Factors
Sensitivity and Specificity

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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