Peak early diastolic mitral annulus velocity by tissue Doppler imaging for the assessment of left ventricular relaxation in subjects with mitral annulus calcification

Abstract

MAC significantly affected LW-e' (and not significantly IS-e') accuracy to reflect LV relaxation. [Formula: see text] and IS-e'2 as surrogates for LW-e' and IS-e', respectively, may correct this inaccuracy.

Impact of left ventricular diastolic function and survival in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

“…[ 19 , 20 , 21 , 22 , 23 , 24 ] MAC and MAC-associated mitral valve disease in the TAVI population show a continuum of severity with large numbers of patients deemed to have “moderate” disease, thus making dichotomization into “significant” and “nonsignificant” mitral valve pathology often impractical. As it is well known that mitral valve pathology can impact E/A and E/e’ measurements,[ 5 , 6 , 7 , 8 , 25 , 26 ] its presence may be a reason why we could not document a stronger relationship between LVEDP and its echocardiographic estimates. On the other hand, using the presence of MAC as an exclusion criterion would result in most of the patients being eliminated from DD grading.…”

“…In addition TAVI patients often have atrial fibrillation (AF), or history of AF, abnormalities of conduction, and/or pacemaker implantation, which all can affect presence of atrial contraction which is a necessary element for the application of the Recommendations grading algorithm [ 2 ]. TAVI patients, besides having AS -associated left ventricular hypertrophy (LVH) and mild /moderate aortic regurgitation (AR), almost always have at least some mitral valve pathology such as severe mitral annular calcification (MAC) accompanied by at least some mitral stenosis (MS) or mitral regurgitation (MR) [ 4 ] [ 5 , 6 , 7 , 8 , 9 ]. They also frequently have coronary artery disease.…”

Validating Left Ventricular Filling Pressure Measurements in Patients with Congestive Heart Failure: CardioMEMS™ Pulmonary Arterial Diastolic Pressure versus Left Atrial Pressure Measurement by Transthoracic Echocardiography

“…In patients with decompensated heart failure or with cardiac resynchronization therapy, E / e ' shows a poor correlation with intracardiac filling pressures especially with large LV volumes because of significant mitral regurgitation and wide QRS leading to abnormal septal motion [ 16 ]. Furthermore, in cases such as heart transplantation, mitral valve repair or replacement, severe mitral annulus calcification, or mitral stenosis, the annular tissue velocities are affected; therefore, E / e ' is not the best indicator of LAP estimation [ 17 ]. Finally, poor acoustic windows may preclude accurate assessment of transmitral Doppler velocities.…”

When does the E/e’ index not work? The pitfalls of oversimplifying diastolic function

“…80 In patients with mitral annular calcification, E is increased and e' reduced 81 so E/e' is unreliable if it is calculated using e' from the lateral annulus. 82 In 50 patients with mitral annular calcification, E/e' demonstrated a weak correlation with mean LV filling pressure (r = .42; P = .003). 83 The E/e' index has been reported to correlate with LVedp in patients with mitral regurgitation secondary to an ischemic or dilated cardiomyopathy (n = 26, r = .61, P < .001) but not in those with primary mitral regurgitation (n = 11, r = .19, n.s.).…”

“… 80 . In patients with mitral annular calcification, E is increased and e’ reduced 81 so E/e’ is unreliable if it is calculated using e’ from the lateral annulus 82 . In 50 patients with mitral annular calcification, E/e’ demonstrated a weak correlation with mean LV filling pressure ( r = .42; P = .003) 83 …”