ALTERATIONS IN TRANSMITRAL FLOW DYNAMICS IN PATIENTS WITH EARLY MITRAL-VALVE CLOSURE AND AORTIC REGURGITATION

Ten patients with severe aortic regurgitation (AR) and early diastolic mitral closure demonstrated by M-mode echocardiography (group I) were compared to 10 age-matched patients with severe AR and normal timing of mitral closure to quantify the accompanying alterations in transmit ral flow dynamics assessed by pulsed Doppler echocardiography. Transmi tral filling period expressed as a fraction of the time available for diastolic filling was significantly shortened in group I patients rela tive to group II patients (0.50 +/- 0.10 vs 1.04 +/- 0.09, p < 0.001) because early mitral closure truncated transmitral filling and obliter ated the atrial contribution to left ventricular filling. The rapid di astolic filling period normalized for the time available for diastolic filling was also shortened for group I patients relative to group II patients (0.49 +/- 0.11 vs 0.64 +/- 0.19; p < 0.05). Early mitral clos ure in group I patients was functionally incomplete because 9 of the 1 0 patients had diastolic mitral regurgitation, which was not detected in any patients in group II (p < 0.001). Thus the group I patients wit h early mitral closure and severe aortic regurgitation had truncated t ransmitral inflow and diastolic mitral regurgitation. These patients h ad higher pulmonary capillary wedge pressures (32 +/- 6 vs 11 +/- 9 mm Hg; p < 0.001) and more severe functional limitation (p < 0.001) than group II patients.