Copyright © 1988 by the European Society of Cardiology.
© 1988 The European Society of Cardiology
Influence of aortic regurgitation on the assessment of the pressure half-time and derived mitral-valve area in patients with mitral stenosis
Thoraxcenter, Erasmus University and Academic Hospital Dijzigt Rotterdam, The Netherlands
*Servizio di Emodinamica Cardiologia, Pordenone, Italy
Received 3 November 1987; revised 29 February 1988; .
Address for reprints: Eugenio Moro. M.D., Laboratorio di Ecocardiografia. Servizio di Emodinamica, Ospedale Civile-Pordenone, Via Montereale. 24. Italy.
Abstract
The influence of aortic regurgitation on the Doppler assessment of pressure half-time (T
) and on the derived calculation of the mitral-valve area has not yet been adequately evaluated in patients with mitral stenosis and associated aortic regurgitation. Therefore this study was undertaken to verify the accuracy of the T method for the noninvasive estimation of mitral-valve area in patients with mitral stenosis and associated aortic regurgitation. Data were obtained from 31 selected patients who underwent cardiac catheterization within 24 h of the noninvasive examination. From the Doppler velocity curve, T was calculated as the interval between the peak transmitral velocity and velocity/
. Mitral-valve area was measured from the T with a computerized system using the equation: 220/T, in cm2. Calculation of the mitral-valve area at catheterization was derived applying the modified Gorlin formula. Mean mitral-valve area, as determined at catheterization, ranged from 0.5 to 2.8 cm2 (1.3±0.6). Mean mitral-valve area, as calculated by continuous-wave Doppler, ranged from 0.7 to 2.7 cm2 (1.5 ± 0.6). Linear-regression analysis of data revealed a good correlation between Gorlin and Doppler measurements of the mitral-valve area (r = 0.90, SEE = 0.28 cm2, P<0.001, y = 1.0x + 0.2). Doppler showed a systematic overestimate of the mitral-valve area (26%) in patients with mitral stenosis and aortic regurgitation as compared to the Gorlin formula. The overestimate of continuous-wave Doppler was even greater (39%) in a subgroup of patients with 2 + or 3 + angiographic aortic regurgitation. Thus the Doppler T method still provides accurate noninvasive estimates of mitral-valve area in patients with mitral stenosis and associated aortic regurgitation. However, when the degree of aortic regurgitation is significant, Doppler can lead to important overestimation of the mitral orifice size.
Key Words: Aortic regurgitation cardiac catheterization • mitral-valve area • Doppler echocardiography
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