Left atrial size, pressure, and v wave height in patients with isolated, severe, pure mitral regurgitation

Pizzarello, Roy A.; Turnier, Jocelyne; Padmanabhan, Venkat; Goldman, Mitchell; Tortólani, Anthony J.

doi:10.1002/ccd.1810100505

Cited by 26 publications

(18 citation statements)

References 14 publications

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“…Influence of MR on LA remodeling. Left atrial enlargement is frequent in chronic organic MR (2,14,20), is progressive (12,26), and is understood as compensatory response to volume overload (11,12,14), resulting in increased atrial compliance and contributing to persistently normal atrial and pulmonary pressures (11,12). Hence, progressive LA enlargement due to organic MR is considered as a mechanism delaying occurrence of symptoms and heart failure.…”

Section: Figure 4 Cardiac Events Associated With La Enlargement Stramentioning

confidence: 98%

Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation

Tourneau

Messika–Zeitoun

Russo

et al. 2010

Journal of the American College of Cardiology

207

146

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Section: Figure 4 Cardiac Events Associated With La Enlargement Stramentioning

confidence: 98%

Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation

Tourneau

Messika–Zeitoun

Russo

et al. 2010

Journal of the American College of Cardiology

207

146

View full text Add to dashboard Cite

show abstract

“…Hence, the size of the LA is greatly influenced by same factors that determine ventricular filling 26 , so constituting a stable parameter that reflects the duration and severity of the lusitropic dysfunction . Consequently, it has been considered that the LA dimension is a potent predictor of adverse events in several clinical situations such as: a) ischemic stroke 30 ; b) chronic atrial fibrillation (AF) 31 ; c) left ventricular failure 32 ; d) mitral regurgitation 33 and e) diastolic dysfunction .…”

Section: Left Atrium Volumementioning

confidence: 99%

Volume atrial esquerdo como índice de função diastólica

Sousa¹

2006

Arq. Bras. Cardiol.

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Congestive heart failure (CHF) is one of the main causes of death and hospital admissions in our country, according to data from Datasus 1 . This clinical syndrome is progressive and characterized by complex cardiac and systemic adaptations, which vary during disease evolution 2 .It has been observed, however, that in approximately 30% to 50% of the individuals who develop CHF, the systolic function estimated through the left ventricular ejection fraction (LVEF) is normal or relatively normal 3 . Thus, the cause of cardiac decompensation in these patients is the left ventricular diastolic dysfunction, justifying the term "diastolic cardiac failure" 4 .Little is known on the natural history of this disease, particularly regarding the mechanisms causing affected patients' death 5 , although its prevalence is known among certain groups, such as the elderly and women, as well as the fact that it usually precedes the systolic dysfunction in most cardiac affections, including Chagas' myocardiopathy .There have been few studies published in literature regarding the incidence of CHF in patients with diastolic dysfunction evidenced by Doppler echocardiography. It has been demonstrated, in a population of individuals older than 65 years with no clinical evidence of cardiac disease, that the detection of this type of dysfunction through Doppler echocardiography has a predictive value for the development of CHF in 11 a 15% of the cases within a five-year period 10 . DIASTOLE AND TYPES OF DIASTOLIC DYSFUNCTIONAccording to the most generally employed clinical concept 11 , the diastolic phase of the cardiac cycle, starting with the closing of the semilunar valves, comprises the largest part of the active ventricular relaxation, with periods of isovolumetric relaxation, and rapid ventricular filling, as well as diastasis or passive filling and, finally, the period that involves atrial contraction. The illustration of this concept is depicted in Figure 1.Even though several independent factors affect the diastolic properties of the left ventricle (LV) its actions converge to the transmitral pressure gradient, which, in fact, is the physical determinant of the left ventricular filling 12 .During the isovolumetric relaxation period, the LV behaves as an isolated chamber, as the aortic and mitral valves are closed; thus, its volume is not altered when there is a progressive decrease of intracavitary pressure. The heart relaxation is also the main determinant of the rapid ventricular filling, which is caused by the opening of the mitral valve as a result of the pressure decrease inside the LV, which is lower than that observed in the left atrium (LA) 13 . It is an energy-dependent process, which corresponds to the active sequestration, contragradient, of calcium ions released from troponin during the contractile activation 14 .The rapid ventricular filling, which under normal circumstances is responsible for 80% of the ventricular filling, is also due to the pressure in the left atrium at the moment of the mitral valve opening (pre...

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“…The LA size was not remarkably large in the patients with severe MR [14], leading to the hypothesis that the V wave was not remarkably large because the LA compliance was high in the patients with current MR. In the near future, we will have more opportunities to perform transcatheter mitral valve repair or percutaneous mitral paravalvular leak closure for the treatment of various kinds of MR under LA pressure monitoring using RHC [18-21].…”

Section: Discussionmentioning

confidence: 99%

“…Correct PCWP position was determined by using the following 3 techniques: (1) observing that the catheter tip was far out in the pulmonary artery and did not move during the cardiac cycle; (2) demonstrating a definite difference between the wave forms in the pulmonary artery and PCWP tracings; and (3) demonstrating clear V waves in all patients and definite “A” waves in patients with a sinus rhythm. The PCWP mean pressure, peak V wave height, and V wave height above the mean were determined [14]. All pressure measurements were averaged from a minimum of 5 heart cycles at end-expiration.…”

Section: Methodsmentioning

confidence: 99%

The Accuracy of a Large V Wave in the Pulmonary Capillary Wedge Pressure Waveform for Diagnosing Current Mitral Regurgitation

Hayashi¹,

Abe²,

Morita³

et al. 2018

Cardiology

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Background: Large V waves in the pulmonary capillary wedge pressure (PCWP) waveform traditionally indicate severe mitral regurgitation (MR). However, our understanding of MR etiology and hemodynamics has changed in recent decades. Objectives: We aimed to reevaluate the association between large V waves and current MR to determine whether traditional large V wave criteria remain optimal. Method: We reviewed 1,964 right heart catheterizations (RHCs) performed at our institution from 2010 to 2017, and retrospectively selected 126 patients with sinus rhythm who underwent echocardiography within 2 days (0.3 ± 0.5 days) of the RHC. The diagnostic accuracy of 3 traditional criteria for large V waves was assessed, and the optimal cut-off points were determined as those with the maximal Youden indices. Results: Severe MR was observed on echocardiography in 26 (21%) patients, including 15 (58%) with Carpentier classification type II MR and 11 (42%) with type IIIB MR. Large V waves, defined as a difference between the peak V wave and mean PCWP ≥10 mm Hg, had a high specificity of 94% (95% confidence interval: 87–98%), but a low sensitivity of 27% (12–48%) for diagnosing severe MR. The optimal cut-off point for the V wave was 3 mm Hg above the mean PCWP, with a sensitivity of 73% (52–88%) and a specificity of 64% (54–73%). Conclusions: For diagnosing current MR, the cut-off point for a large V wave should be reduced from that previously employed for rheumatic valvular heart disease. This information may be useful in guiding contemporary transcatheter therapies for MR under RHC monitoring.

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Left atrial size, pressure, and v wave height in patients with isolated, severe, pure mitral regurgitation

Cited by 26 publications

References 14 publications

Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation

Impact of Left Atrial Volume on Clinical Outcome in Organic Mitral Regurgitation

Volume atrial esquerdo como índice de função diastólica

The Accuracy of a Large V Wave in the Pulmonary Capillary Wedge Pressure Waveform for Diagnosing Current Mitral Regurgitation

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