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- Title
Mitral valve resistance determines hemodynamic consequences of severe rheumatic mitral stenosis and immediate outcomes of percutaneous valvuloplasty.
- Authors
Sanati, Hamidreza; Zolfaghari, Reza; Samiei, Niloufar; Rezaei, Yousef; Chitsazan, Mitra; Zahedmehr, Ali; Shakerian, Farshad; Kiani, Reza; Firouzi, Ata; Rezaei Tabrizi, Reza
- Abstract
Introduction The mitral valve area ( MVA) poorly reflects the hemodynamic status of ( MS). In this study, we compared the MVA with mitral valve resistance ( MVR) with regard to the determination of hemodynamic consequences of MS and the immediate outcomes of percutaneous balloon mitral valvuloplasty ( PBMV). Methods In a prospective study, 36 patients with severe rheumatic MS with left ventricular ejection fraction ( LVEF) >50% were evaluated. They underwent transthoracic echocardiography ( TTE) and catheterization. The MVA was measured by two-dimensional planimetry and pressure half-time ( PHT), and the MVR was calculated using the equation: 1333 × transmitral pressure gradient mean transmitral diastolic flow rate. Results The patients' mean age was 47.8±10.5 years. MVR ≥140.6 dynes·s/cm5 detected systolic pulmonary arterial pressure ( sPAP) >55 mm Hg with a sensitivity of 100% and a specificity of 74%. The sensitivity and specificity of MVA<0.75 cm2 to discriminate elevated sPAP were 81% and 89%, respectively. PHT ≥323.5 mseconds had a sensitivity of 78% and a specificity of 96% to detect an elevated sPAP. To predict a successful PBMV, preprocedural MVR ≥106.1 dynes·s/cm5 had a sensitivity of 100% and a specificity of 67% (area under the curve [ AUC]=0.763; 95% confidence interval [ CI]=0.520-1.006; P=.034); preprocedural MVA <0.95 cm2 had a sensitivity of 78% and a specificity of 73% ( AUC=0.730; 95% CI=0.503-0.956; P=.065); and preprocedural PHT ≥210.5 mseconds had a sensitivity of 73% and a specificity of 78% ( AUC=0.707; 95% CI=0.474-0.941; P=.095). Conclusions MVR seems to be more accurate than MVA in determining the hemodynamic consequences of severe MS as determined by sPAP. In addition, preprocedural MVR detected successful PBMVs.
- Subjects
IRAN; ANTHROPOMETRY; ARTERIES; BLOOD pressure; CARDIAC catheterization; CHI-squared test; CONFIDENCE intervals; STATISTICAL correlation; ECHOCARDIOGRAPHY; CARDIAC contraction; HEART physiology; LEFT heart ventricle; CARDIAC surgery; HEMODYNAMICS; LONGITUDINAL method; MITRAL stenosis; MITRAL valve; PEPTIDE hormones; PREOPERATIVE care; PROBABILITY theory; RHEUMATIC heart disease; SEVERITY of illness index; RECEIVER operating characteristic curves; DESCRIPTIVE statistics; VENTRICULAR ejection fraction; DISEASE complications
- Publication
Echocardiography, 2017, Vol 34, Issue 2, p162
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13448