Invasive assessment of mitral regurgitation: Comparison of hemodynamic parameters

Freihage, Jeffrey H.; Joyal, Dominique; Arab, Dinesh; Dieter, Robert S.; Loeb, Henry S.; Steen, Lowell; Lewis, Bruce E.; Liu, Jayson C.; Leya, Ferdinand

doi:10.1002/ccd.20940

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…Whereas immediately after MR reduction, reduction in the amplitude of the v wave can be seen , the mean left atrial pressure, pulmonary capillary wedge pressure, pulmonary arterial pressure, and the left ventricular end‐diastolic pressure can decrease or remain unchanged . In the majority of patients, a reduction in MR is associated with an increase in stroke volume and concomitant decrease in systemic vascular resistance . This results in an improvement in cardiac output and cardiac index.…”

Section: Discussionmentioning

confidence: 99%

Influence of percutaneous mitral valve repair using the MitraClip® system on renal function in patients with severe mitral regurgitation

Rassaf

Balzer

Rammos

et al. 2014

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Influence of percutaneous mitral valve repair using the MitraClip® system on renal function in patients with severe mitral regurgitation

Rassaf

Balzer

Rammos

et al. 2014

Cathet Cardio Intervent

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“…) or should mitral regurgitation be present (Freihage et al . ), one would anticipate that the characteristics of the v wave may be altered, perhaps substantially, depending on many variables including the volume and rate of regurgitation and the pressure at which it occurs.…”

Section: Discussionmentioning

confidence: 99%

“…For example, quantification of backward waves might help assess the severity of mitral regurgitation (Freihage et al . ) or the effects of a stiff LA (Pilote et al . ; Mehta et al .…”

Section: Discussionmentioning

confidence: 99%

Genesis of the characteristic pulmonary venous pressure waveform as described by the reservoir‐wave model

Bouwmeester

Belenkie

Shrive

et al. 2014

The Journal of Physiology

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Key pointsr In pressure flow data from a pulmonary vein, we use the reservoir wave model to separate the effects of an elastic venous reservoir from the effects of waves created by the heart. r Wave intensity analysis was used to separate the effects of waves generated upstream by the right ventricle from the effects of waves generated downstream by the left atrium and left ventricle.r Most waves are created by the left atrium and left ventricle and can be linked to events that occur during the cardiac cycle.r Waves transmitted through the pulmonary circulation are attenuated less when blood volume is increased but are attenuated more and delayed when the lungs are expanded.r The drainage of pulmonary arterial and venous reservoirs are responsible for substantial changes in measured pulmonary venous pressure and flow but waves are associated with the conventional landmarks of these characteristic waveforms.Abstract Conventional haemodynamic analysis of pulmonary venous and left atrial (LA) pressure waveforms yields substantial forward and backward waves throughout the cardiac cycle; the reservoir wave model provides an alternative analysis with minimal waves during diastole. Pressure and flow in a single pulmonary vein (PV) and the main pulmonary artery (PA) were measured in anaesthetized dogs and the effects of hypoxia and nitric oxide, volume loading, and positive-end expiratory pressure (PEEP) were observed. The reservoir wave model was used to determine the reservoir contribution to PV pressure and flow. Subtracting reservoir pressure and flow resulted in 'excess' quantities which were treated as wave-related. Wave intensity analysis of excess pressure and flow quantified the contributions of waves originating upstream (from the PA) and downstream (from the LA and/or left ventricle (LV)). Major features of the characteristic PV waveform are caused by sequential LA and LV contraction and relaxation creating backward compression (i.e. pressure-increasing) waves followed by decompression (i.e. pressure-decreasing) waves. Mitral valve opening is linked to a backwards decompression wave (i.e. diastolic suction). During late systole and early diastole, forward waves originating in the PA are significant. These waves were attenuated less with volume loading and delayed with PEEP. The reservoir wave model shows that the forward and backward waves are negligible during LV diastasis and that the changes in pressure and flow can be accounted for by the discharge of upstream reservoirs. In sharp contrast, conventional analysis posits forward and backward waves such that much of the energy of the forward wave is opposed by the backward wave.

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Mitral Valve Stenosis

Kern¹,

Lim²

2018

Hemodynamic Rounds

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Invasive assessment of mitral regurgitation: Comparison of hemodynamic parameters

Abstract: Invasive hemodynamic assessment of MR severity could be enhanced by calculating our new ratio, V(a)/LV(a), due to its ability to account for LV work that is lost to the LA with a proportional decrease in forward or useful LV work with progressively increasing severity of MR.

Cited by 8 publications

References 6 publications

Influence of percutaneous mitral valve repair using the MitraClip® system on renal function in patients with severe mitral regurgitation

Influence of percutaneous mitral valve repair using the MitraClip® system on renal function in patients with severe mitral regurgitation

Genesis of the characteristic pulmonary venous pressure waveform as described by the reservoir‐wave model

Mitral Valve Stenosis

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