J Cardiovasc Ultrasound.  2008 Jun;16(2):48-53. 10.4250/jcu.2008.16.2.48.

Systolic Mitral Annular Velocity as a Simple Marker of Left Ventricular Peak Systolic dP/dt in Patients with Significant Mitral Regurgitation

• Kim MS
• Kim YJ
• Kim HK
• Kwon DA
• Kim DH
• Seo JB
• Yang HM
• Choi DH
• Sohn DW

• KMID: 1491041
• DOI: http://doi.org/10.4250/jcu.2008.16.2.48

Abstract

BACKGROUND: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S') can be a good marker of LV dP/dt.
METHODS
We studied 62 patients (25 men, age: 47+/-15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S' velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated.
RESULTS
Mean LV ejection fraction was 60+/-6% and regurgitant fraction was 59+/-15%. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S' velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction.
CONCLUSION
Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.

Keyword

Mitral regurgitation; Systolic mitral annulus velocity; dP/dt

MeSH Terms

Catheterization
Catheters
Echocardiography, Doppler
Humans
Male
Mitral Valve Insufficiency

Figure

• 

  Fig. 1 The correlation between peak mitral annulus velocity (S') and LV dP/dt-Doppler. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01).

• 

  Fig. 2 The correlation between LV dP/dt-Doppler and peak dP/dt-cath. In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03).

• 

  Fig. 3 The correlation between S' and peak dP/dt-cath. S' velocity did not correlate with LV dP/dt-cath (r=0.03, p=0.94) because of small number of patients.

• 

  Fig. 4 The correlation between S' and ejection fraction (EF). S' velocity did not correlate with EF (r=0.21, p=0.10).

• 

  Fig. 5 The correlation between EF and peak dP/dt-cath. EF did not correlate with preoperative LV dP/dt-Doppler statistically (r=0.26, p=0.15). In patients with significant MR, EF did not reflect true LV systolic contractility.

Reference

1. Urschel CW, Covell JW, Sonnenblick EH, Ross J Jr, Braunwald E. Myocardial mechanics in aortic and mitral valvular regurgitation: the concept of instantaneous impedance as a determinant of the performance of the intact heart. J Clin Invest. 1968. 47:867–883.

2. Eckberg DL, Gault JH, Bouchard RL, Karliner JS, Ross J Jr. Mechanics of left ventricular contraction in chronic severe mitral regurgitation. Circulation. 1973. 47:1252–1259.

3. Wisenbaugh T, Spann JF, Carabello BA. Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitation. J Am Coll Cardiol. 1984. 3:916–923.

4. Starling MR, Kirsh MM, Montgomery DG, Gross MD. Impaired left ventricular contractile function in patients with long-term mitral regurgitation and normal ejection fraction. J Am Coll Cardiol. 1993. 22:239–250.

5. Brickner ME, Starling MR. Dissociation of end systole from end ejection in patients with long-term mitral regurgitation. Circulation. 1990. 81:1277–1286.

6. Carabello BA. Preservation of left ventricular function in patients with mitral regurgitation: a realistic goal for the nineties. J Am Coll Cardiol. 1990. 15:564–565.

7. Levine HJ. Is valve surgery indicated in patients with severe mitral regurgitation even if they are asymptomatic? Cardiovasc Clin. 1990. 21:161–170.

8. Borow KM, Green LH, Mann T, Sloss LJ, Braunwald E, Collins JJ, Cohn L, Grossman W. End-systolic volume as a predictor of postoperative left ventricular performance in volume overload from valvular regurgitation. Am J Med. 1980. 68:655–663.

9. Zile MR, Gaasch WH, Carroll JD, Levine HJ. Chronic mitral regurgitation: predictive value of preoperative echocardiographic indexes of left ventricular function and wall stress. J Am Coll Cardiol. 1984. 3:235–242.

10. Enriquez-Sarano M, Tajik AJ, Schaff HV, Orszulak TA, Bailey KR, Frye RL. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation. 1994. 90:830–837.

11. Carabello BA, Crawford FA Jr. Valvular heart disease. N Engl J Med. 1997. 337:32–41.

12. Enriquez-Sarano M, Tajik AJ, Schaff HV, Orszulak TA, McGoon MD, Bailey KR, Frye RL. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol. 1994. 24:1536–1543.

13. Schuler G, Peterson KL, Johnson A, Francis G, Ashburn W, Dennish G, Daily PO, Ross J Jr. Temporal response of left ventricular performance to mitral valve surgery. Circulation. 1979. 59:1218–1231.

14. Zile MR, Gaasch WH, Levine HJ. Left ventricular stress-dimension-shortening relations before and after correction of chronic aortic and mitral regurgitation. Am J Cardiol. 1985. 56:99–105.

15. Carabello BA, Nolan SP, McGuire LB. Assessment of preoperative left ventricular function in patients with mitral regurgitation: value of the end-systolic wall stress-end-systolic volume ratio. Circulation. 1981. 64:1212–1217.

16. Reed D, Abbott RD, Smucker ML, Kaul S. Prediction of outcome after mitral valve replacement in patients with symptomatic chronic mitral regurgitation. The importance of left atrial size. Circulation. 1991. 84:23–34.

17. Crawford MH, Souchek J, Oprian CA, Miller DC, Rahimtoola S, Giacomini JC, Sethi G, Hammermeister KE. Determinants of survival and left ventricular performance after mitral valve replacement. Department of Veterans Affairs Cooperative Study on Valvular Heart Disease. Circulation. 1990. 81:1173–1181.

18. Pai RG, Bansal RC, Shah PM. Doppler-derived rate of left ventricular pressure rise. Its correlation with the postoperative left ventricular function in mitral regurgitation. Circulation. 1990. 82:514–520.

19. Assmann PE, Slager CJ, Dreysse ST, van der Borden SG, Oomen JA, Roelandt JR. Two-dimensional echocardiographic analysis of the dynamic geometry of the left ventricle: the basis for an improved model of wall motion. J Am Soc Echocardiogr. 1988. 1:393–405.

20. McDonald IG. The shape and movements of the human left ventricle during systole. A study by cineangiography and by cineradiography of epicardial markers. Am J Cardiol. 1970. 26:221–230.

21. Slager CJ, Hooghoudt TE, Serruys PW, Schuurbiers JC, Reiber JH, Meester GT, Verdouw PD, Hugenholtz PG. Quantitative assessment of regional left ventricular motion using endocardial landmarks. J Am Coll Cardiol. 1986. 7:317–326.

22. Sohn DW, Chung WY, Chai IH, Zo JH, Lee MM, Park YB, Choi YS, Lee YW. Mitral Annulus Velocity in the Noninvasive Estimation of Left Ventricular Peak dP/dt. Am J Cardiol. 2001. 87:933–936.

23. Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ, Krohn MJ, Mays JM. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993. 87:841–848.

24. Ascah KJ, Stewart WJ, Gillam LD, Triulzi MO, Newell JB, Weyman AE. Calculation of transmitral flow by Doppler echocardiography: a comparison of methods in a canine model. Am Heart J. 1989. 117:402–411.

25. Bargiggia GS, Bertucci C, Recusani F, Raisaro A, de Servi S, Valdes-Cruz LM, Sahn DJ, Tronconi L. A new method for estimating left ventricular dP/dt by continuous wave Doppler-echocardiography. Validation studies at cardiac catheterization. Circulation. 1989. 80:1287–1292.

26. Nazli C, Kinay O, Ergene O, Yavuz T, Gedikli O, Hoscan Y, Ozaydin M, Altinbas A, Dogan A, Kahraman H, Acar G. Use of tissue Doppler echocardiography in early detection of left ventricular systolic dysfunction in patients with mitral regurgitation. Int J Cardiovasc Imaging. 2003. 19:199–209.

27. Baim DS. Grossman's cardiac catheterization, angiography, and intervention. 2006. 7th Ed. Boston, MA: Lippincott Williams & Wilkins;317.

28. Chen C, Rodriguez L, Guerrero JL, Marshall S, Levine RA, Weyman AE, Thomas JD. Noninvasive estimation of the instantaneous first derivative of left ventricular pressure using continuous-wave Doppler echocardiography. Circulation. 1991. 83:2101–2110.

29. Agicola E, Galderisi M, Oppizzi M, Schinkel AF, Maisano F, De Bonis M, Margonato A, Maseri A, Alfieri O. Pulsed tissue Doppler imaging detects early myocardial dysfuntion in asymptomatic patients with severe mitral regurgitation. Heart. 2004. 90:406–410.