L. Thomas et al., PEAK MITRAL INFLOW VELOCITY PREDICTS MITRAL REGURGITATION SEVERITY, Journal of the American College of Cardiology, 31(1), 1998, pp. 174-179
Objectives. Mitral regurgitation (MR) is a common echocardiographic fi
nding; however, there is no simple accurate method for quantification,
The aim of this study was to develop an easily measured screening var
iable for hemodynamically significant MR. Background. The added regurg
itant volume in MR increases the left atrial to left ventricular gradi
ent, which then increases the peak mitral inflow or the peak E wave ve
locity, Our hypothesis was that peak E wave velocity and the E/A ratio
increase in proportion to MR severity. Methods. We performed a retros
pective analysis of 102 consecutive patients with varying grades of MR
seen in the Adult Echocardiography Laboratory at the University of Ca
lifornia, San Francisco. Peak E wave velocity, peak A wave velocity, E
/A ratio and E wave deceleration time were measured in all patients, T
he reference standard for MR was qualitative echocardiographic evaluat
ion by an expert and quantitation of regurgitant fraction using two di
mensional and Doppler echocardiography. Results. Peak E wave velocity
was seen to increase in proportion to MR severity, with a significant
difference between the different groups (F = 37, p < 0.0001), Peak E w
ave velocity correlated with regurgitant fraction (r = 0.52, p < 0.001
), Furthermore, an E wave velocity >1.2 m/s identified 24 of 27 patien
ts with severe MR (sensitivity 86%, specificity 86%, positive predicti
ve value 75%), An A wave dominant pattern excluded the presence of sev
ere MR, The E/A ratio also increased in proportion to MR severity, Pea
k A wave velocity and E wave deceleration time showed no correlation w
ith MR severity. Conclusions. Peak E wave velocity is easy to obtain a
nd is therefore widely applicable in clinical practice as a screening
tool for evaluating MR severity. (C) 1998 by the American College of C
ardiology.