M. Enriquez-sarano et al., Determinants of pulmonary venous flow reversal in mitral regurgitation andits usefulness in determining the severity of regurgitation, AM J CARD, 83(4), 1999, pp. 535-541
Citations number
39
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Pulmonary venous flow (PVF) reversal is observed in mitral regurgitation (M
R) and can be detected by Doppler echocardiography. However, the determinan
ts of PVF alterations in MR have not been analyzed with simultaneous quanti
tative methods, and the diagnostic accuracy of flow reversal is uncertain.
Prospectively, in 128 patients with isolated MR of various degrees (regurgi
tant fraction 4% to 81%), Doppler echocardiography was used to measure PVF
velocity simultaneously to quantify MR by 2 methods and to perform a compre
hensive hemodynamic assessment. Systolic PVF velocity was 4 =/- 56 cm/s (sy
stolic flow reversal in 39 patients) and showed the strongest correlations
with mitral effective regurgitant orifice (r = -0.56, p <0.0001). In multiv
ariate analysis, larger effective regurgitant orifice (p <0.0001), eccentri
c jets (p = 0.0023), longer jets (p = 0.0033), and lower mitral regurgitant
velocity (p = 0.0015) were independent determinants of decreased systolic
PVF velocity. In organic MR, increased filling pressures were associated wi
th systolic PVF reversal. Blunted systolic flow was associated with shelter
mitral deceleration time (p <0.0001) and enlarged left atrium (p = 0.0007)
. For the diagnosis of severe MR (regurgitant orifice greater than or equal
to 35 mm(2), regurgitant fraction greater than or equal to 50%), systolic
flow reversal sensitivity was 61% and 60%, and specificity was 92% and 85%,
respectively. Among 29 patients in whom surgery demonstrated severe mitral
lesions, 12 (41%) had no systolic flow reversal preoperatively. In patient
s with MR, the determinants of systolic PVF are complex and, in addition to
the degree of MR, include the hemodynamic consequences of MR, let characte
ristics, left ventricular filling, and left atrial volume alterations. Cons
equently, systolic PVF reversal is a useful sign of severe MR but of relati
vely low sensitivity, emphasizing the importance of quantifying MR. (C) 199
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