Determinants of pulmonary venous flow reversal in mitral regurgitation andits usefulness in determining the severity of regurgitation

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 9 by Excerpta Medico, Inc.