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- Title
The impact of cardiac rhythm on the mitral valve area and gradient in patients with mitral stenosis.
- Authors
Arı, Hasan; Arı, Selma; Karakuş, Alper; Camcı, Sencer; Doğanay, Kübra; Tütüncü, Ahmet; Melek, Mehmet; Bozat, Tahsin
- Abstract
Objective: The aim of this study was to evaluate the effect of cardiac rhythm on the echocardiographic mitral valve area (MVA) and transmitral gradient calculation in relation to net atrioventricular compliance (Cn). Methods: Patients (n=22) with mild or moderate pure rheumatic mitral stenosis (MS) (MVA <2 cm2 and MVA >1 cm2) and atrial fibrillation (AF) were evaluated. All patients underwent transthoracic electrical DC cardioversion under amiodarone treatment. Nineteen of the 22 patients were successfully converted to sinus rhythm (SR). The patients were evaluated with transthoracic echocardiography before and two to three days after DC cardioversion. In order to deal with variable R-R intervals, the measurements were averaged on five to eight consecutive beats in AF. Cn was calculated with a previously validated equation [Cn (mL/mm Hg)=1.270 × MVA/E-wave downslope]. The Cn difference between AF and SR was calculated as follows: [(AF Cn−SR Cn)/AF Cn] × 100. The percentage gradient (mean or ma×imal) difference between AF and SR was calculated as follows: [AF gradient (mean or ma×imal) - SR gradient (mean or ma×imal)]/[AF gradient (mean or ma×imal)] × 100. Results: The MVA was lower (MVA planimetric; 1.62±0.29 vs. 1.54±0.27; p=.003, MVA PHT; 1.66±0.30 vs. 1.59±0.26; p=0.01) but transmitral gradient (mean gradient; 6.49±2.51 vs. 8.89±3.52; p=0.001, ma×imal gradient: 16.94±5.11 vs. 18.57±4.54; p=0.01) and Cn values (5.37±0.77 vs. 6.26±0.64; p<0.001) were higher in the AF than SR. There was a significant correlation between Cn difference and transmitral gradient difference (mean and ma×imal) (Cn difference-mean gradient difference; r=0.46; p=0.05; Cn difference-ma×imal gradient difference; r=0.72; p=0.001). Conclusion: Cardiac rhythm has a significant impact on echocardiographic evaluation of MVA, transmitral gradient, and Cn in patients with MS.
- Subjects
ECHOCARDIOGRAPHY; MITRAL stenosis; ELECTRIC countershock; MITRAL valve; ATRIAL fibrillation; PATIENTS; THERAPEUTICS
- Publication
Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi, 2017, Vol 18, Issue 2, p90
- ISSN
2149-2263
- Publication type
Article
- DOI
10.14744/AnatolJCardiol.2017.7614