Effect of heart rate on transmitral flow velocity profile and Doppler measurements of mitral valve area in patients with mitral stenosis

Abstract

To study the effect of heart rate changes on Doppler measurements of mitral valve area atrial pacing was performed in 14 patients with mitral stenosis and sinus rhythm. Continuous wave Doppler and haemodynamic measurements were performed simultaneously at rest and during pacing-induced tachycardia. (1) Mitral valve area was determined using the conventional pressure half time method. (2) Additionally, mitral valve area was calculated with a combined Doppler and thermodilution technique according to the continuity equation. (3) Simultaneous invasive measurements were used for calculation of the mitral valve area according to the Gorlin formula. With increasing heart rate (69 +/- 13-97 +/- 15-114 +/- 13 beats min-1) mitral valve area either determined by the continuity equation (1.0 +/- 0.2-1.0 +/- 0.3-1.1 +/- 0.4 cm2) or the Gorlin formula (1.2 +/- 0.3-1.2 +/- 0.4-1.3 +/- 0.4 cm2) remained constant. Both methods correlated closely not only at rest (r = 0.88, SEE = 0.11 cm2, P less than 0.001), but also during atrial pacing (first level: r = 0.95, SEE = 0.10 cm2, P less than 0.001, second level: r = 0.95, SEE = 0.13 cm2, P less than 0.001). In contrast, mitral valve area calculated according to the pressure half time method increased significantly during atrial pacing (1.0 +/- 0.3-1.8 +/- 0.5-2.0 +/- 0.5 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnostic Role of Incidental Premature Contractions During Doppler Echocardiography

“…Indeed, the PHT method has been shown to overestimate Gorlin-derived MVA at heart rates >80 beats/min. 7 In our patient, the resting heart rate was 75 beats/min (RR interval, 800 ms), which highlights the potential diagnostic role of PSVCs even at slower resting heart rates. Although the accuracy of the PHT method has not been tested specifically after PSVC, it has been well validated in patients with atrial fibrillation.…”

Immediate Post-Procedural and Discharge Assessment of Mitral Valve Function Following Transcatheter Edge-to-Edge Mitral Valve Repair: Correlation and Association with Outcomes

“…Therefore, it is susceptible to subjective interpretation and is a source for the variability of reports [18,29]. Likewise, MVPG is also deeply influenced by the changes in the loading conditions, between assessments, as well as by MR severity itself because the trans-mitral pressure gradient is a function of the square of the trans-valvular flow rate [31,32,34,35]. Decreased diastolic filling time during tachycardia, severe MR, high trans-mitral flow because of hyperdynamic states or anemia, for instance, will increase the MVPG.…”

Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography

“…Decreased diastolic filling time in tachycardia results in elevation of the LA pressure and the transmitral mean gradient. High transmitral flow because of hyperdynamic states (e.g., sepsis, hepatic failure) or severe MR will increase the mean gradient 9 and cause overestimation of MS severity. Conversely, low cardiac output causes underestimation of MS severity.…”

“…With increasing heart rate, the PHT method overestimates MVA. 9 Significant aortic regurgitation (AR) contributes to diastolic LV filling and causes significant shortening of PHT with MVA overestimation. 15 This effect is highly dependent on chamber compliance and on the severity of MS, which may explain conflicting results in other studies regarding the impact of AR on PHT.…”