Match and mismatch between opening area and resistance in mild and moderate rheumatic mitral stenosis.

El‐Dosouky, Ibtesam Ibrahim

Background Mitral valve resistance ( MVR) is a hemodynamic consequence of mitral stenosis ( MS), but it has no clear threshold with a shortage of data to be reliable. We aimed to investigate match and mismatch between opening area and resistance especially in patients with moderate and mild MS. Methods This study comprised 88 patients with moderate and mild rheumatic MS. Transthoracic echocardiographic study estimated the following: mitral valve area ( MVA) by both planimetry (2D) and pressure half-time ( PHT), mitral valve score ( MVS), mean transmitral pressure gradient ( MPG), diastolic filling time ( DFT), left ventricular out flow tract diameter ( LVOTd) and velocity-time integral ( LVOTvti), and MVR = MPG/aortic flow ratio [( LVOTd) ( LVOTvti)/ DFT] in dynes·s/cm5. Patients were classified into two groups: group 1 (51 patients) with matched MVR and group 2 (37 patients) with mismatched higher MVR. Results In the matched group, moderate MS showed MVR <105 dynes·s/cm5 and <76dynes·s/cm5 with mild MS. Group 2 compared to group 1 had higher NYHA class (1.4±0.6 vs 1.2±0.4, P<.05) and higher MVS (8.1±1.8 vs 7±0.9, P<.05). MVR showed positive correlation with MVS (r=.5, P<.05), and logistic regression analysis showed that MVS is the only independent predictor of the MVR severity in the mismatched group (i.e., with higher MVR compared to the ROC analysis results) (B± SE=6.997±2.826, t=2.476, 95% CI 1.241±12.752 with an odds ratio=0.412, P<.05). Conclusion On investigating match and mismatch between opening area and resistance, the only independent predictor of mismatch is the mitral valve score.

MITRAL valve; BLOOD pressure; STATISTICAL correlation; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; HEART diseases; CARDIAC patients; LEFT heart ventricle; HEART physiology; HEMODYNAMICS; INFORMED consent (Medical law); MEDICAL history taking; MITRAL stenosis; T-test (Statistics); RHEUMATIC heart disease; DATA analysis; CONTROL groups; CROSS-sectional method; RECEIVER operating characteristic curves; DATA analysis software; DESCRIPTIVE statistics; MANN Whitney U Test; DIAGNOSIS; PHYSIOLOGY

Echocardiography, 2016, Vol 33, Issue 12, p1801

0742-2822

Academic Journal

10.1111/echo.13349