Abstract 10733: Tissue Doppler Derived Mitral Annular Velocity and Acceleration During Isovolumic Contraction Predict Pulmonary Capillary Wedge Pressure in Patients With Significant Mitral Regurgitation
Background: We previously reported that tissue Doppler derived mitral annular isovolumic contraction velocity (IVV) and acceleration (IVA) predict pulmonary capillary wedge pressure (PCWP) in patients with systolic dysfunction. Most echocardiographic predictors of PCWP are inaccurate in mitral regurgitation (MR).
Aim: Study the ability of IVV and IVA to detect PCWP in MR.
Methods: We studied 39 patients with significant MR. PCWP was invasively measured. IVV and IVA were measured, in addition to the ratio IVRT/Te’-E (IVRT: isovolumic relaxation time, and Te’-E: time difference between the onset of mitral annular e’ and mitral flow E-wave).
Results: Mean age was 60.2±13.5 years, 16 patients (41%) were females, and 16 (41%) had atrial fibrillation (Af). Ejection fraction (Ef) was 53.7±14.9% and was <55% in 15 patients (38.4±12.6) and ≥55% in 24 patients (63.3±4.7). PCWP was 13.5±9.1 mmHg and was <12 mmHg in 23 patients (7.0±2.1) and ≥12 mmHg in 16 patients (22.9±6.9). IVV and IVA were possible in all patients, however IVRT/Te’-E was impossible in 11 patients because of Te’-E was zero. PCWP correlated significantly with IVV, IVA and IVRT/Te’-E ; overall (r= -0.737, -0.892, -0.815, all p<0.001), in EF<55% (r= -0.847, -0.928, -0.898, all p<0.001), in EF ≥55 (r= -0.447, -0.699, -0.762, p=0.02, <0.001, <0.001), in sinus rhythm (r= -0.769, -0.927, -0.835, all p<0.001), and in Af (r= -0.695, -0.828, -0.793, p=0.003,<0.001, 0.006). By multivariate stepwise regression, IVA and IVRT/Te’-E were comparable, with a stronger IVA correlation (adjusted r2: 0.91, IVV: beta= -0.22, p=0.07, IVA: beta= -0.6, p<0.001, and IVRT/Te’-E: beta= -0.36, p=0.01). IVV and IVA were significantly lower when PCWP ≥ 12 mmHg compared to their values when PCWP <12 mmHg (IVV:3.9±1.6 vs. 6.2±1.3 cm/s, p<0.001; IVA:1.27±0.46 vs. 2.25±0.23 m/s2, p<0.001). ROC-curve suggested that IVV and IVA effectively detect PCWP>12 mmHg with excellent sensitivities and specificities (AUC= 0.859, 0.984, 95% CI: 0.728 to 0.99 and 0.952 to 1.000; respectively)[[Unable to Display Character:
Conclusion: IVV and IVA correlate with PCWP in patients with MR with and without systolic dysfunction, in sinus and in Af rhythms, thus can be alternatives to the tedious IVRT/Te’-E, especially when IVRT/Te’-E is impossible because of Te’-E value of Zero.
- © 2013 by American Heart Association, Inc.