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(Circulation. 2000;102:2378.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis

An Exercise Echocardiographic Study

Ehud Schwammenthal, MD; Zvi Vered, MD; Oren Agranat, MD; Elieser Kaplinsky, MD; Babeth Rabinowitz, MD; Micha S. Feinberg, MD

From the Heart Institute, Sheba Medical Center, Tel Hashomer, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv.

Background—The decay of the pressure gradient across a stenotic mitral valve is determined by the size of the orifice and net AV compliance (C_n). We have observed a group of symptomatic patients, usually in sinus rhythm, characterized by pulmonary hypertension (particularly during exercise) despite a relatively large mitral valve area by pressure half-time. We speculated that this discrepancy was due to low atrial compliance causing both pulmonary hypertension and a steep decay of the transmitral pressure gradient despite significant stenosis. We therefore tested the hypothesis that C_n is an important physiological determinant of pulmonary artery pressure at rest and during exercise in mitral stenosis.

Methods and Results—Twenty patients with mitral stenosis were examined by Doppler echocardiography. C_n, calculated from the ratio of effective mitral valve area (continuity equation) and the E-wave downslope, ranged from 1.7 to 8.1 mL/mm Hg. Systolic pulmonary artery pressure (PAP) increased from 43±12 mm Hg at rest to 71±23 mm Hg (range, 40 to 110 mm Hg) during exercise. There was a particularly close correlation between C_n and exercise PAP (r=-0.85). Patients with a low compliance were more symptomatic (P<0.025). Catheter- and Doppler-derived values for C_n, determined in 10 cases, correlated well (r=0.79).

Conclusions—C_n, which can be noninvasively assessed, is an important physiological determinant of PAP in mitral stenosis. Patients with low C_n represent an important clinical entity, with symptoms corresponding to severe increases in PAP during stress echocardiography.

Key Words: mitral valve • echocardiography • exercise • hemodynamics

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