QUANTITATION OF MITRAL REGURGITATION USING THE SYSTOLIC DIASTOLIC PULMONARY VENOUS FLOW VELOCITY RATIO/

Objectives. The purpose of this study was to test the hypothesis that pulmonary venous flow velocity ratios during systole and diastole in p atients with mitral regurgitation (MR) correctly predict the quantitat ive degree of MR. Background. Pulmonary venous how velocity measuremen ts have thus far been used only for the qualitative assessment of MR. Recent studies have evaluated this method using transesophageal echoca rdiography against semiquantitative references. Methods. In 100 patien ts without aortic regurgitation or atrial fibrillation and with left v entricular (LV) ejection fraction > 45%, MR was assessed by quantitati ve echocardiographic Doppler and color Doppler, providing forward and total LV stroke volume for the calculation of the mitral regurgitant f raction (RFstandard), the reference parameter, and also supplying mitr al regurgitant orifice area (ROA) values and the RF by the how converg ence method (RFPISA [proximal isovelocity surface areal]). Measurement s of pulmonary venous flow velocity time integral values during systol e to diastole (VTIs/VTId) were obtained and tested for their predictab ility of ROA, RFstandard and RFPISA. R esults. There was an inverse an d significant correlation between VTIs/VTId and ROA, RFPISA and RFstan dard, respectively: RFstandard = 49 -20 VTIs/VTId, r = 0.77, p = 0.000 1. A principal source of variability in the relation between VTIs/VTId and RFstandard was the presence of mitral valve prolapse as the cause of MR. Pulmonary venous flow reversal (VTIs/VTId < 0) correctly ident ified severe MR with 52% sensitivity, 96% specificity and 80% positive and 87% negative predictive accuracy. Conclusions. The VTIs/VTId rati o allows a moderately accurate assessment of the severity of MR. (C) 1 998 by the American College of Cardiology.