Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: The advantage of end-diastolic markers

Enhanced early mitral flow and reduced systolic pulmonary vein flow may be caused both by increased left ventricular pressure as the result of diastol ic dysfunction and by increased transmitral now as the result of mitral reg urgitation. Nevertheless, Doppler parameters are widely used to predict lef t ventricular filling pressure. We aimed to analyze the interference of mit ral regurgitation with Doppler parameters usually used to estimate left ven tricular filling pressure and to identify markers independent of mitral reg urgitation, which could reliably estimate increased left ventricular fillin g pressure. Eighty-four patients (age, 62 +/- 9 years; 82% men) had a compl ete echocardiographic Doppler examination. Transmitral E- and A-wave veloci ty, E deceleration time and A duration, pulmonary vein systolic and diastol ic velocities, and reversal now duration and maximal and minimal left atria l volumes were measured. The difference between the duration of pulmonary v ein and mitral A waves was calculated (A'-A). Mitral regurgitant volume was quantitatively assessed by echocardiography. Left ventricular end-diastoli c pressure was measured invasively. Patients had a wide range of left ventr icular ejection fraction (14% to 70%), mitral regurgitant volume (0 to 94 m L), and left ventricular end-diastolic pressure (3 to 37 mm Hg). E velocity , E/A, pulmonary vein systolic and diastolic, and systo-diastolic ratios we re significantly and independently correlated with both left ventricular en d-diastolic pressure and mitral regurgitant volume. A'-A showed a strong co rrelation with left ventricular end-diastolic pressure (r = 0.70; P < .0001 ), but the relation with mitral regurgitant volume was not significant (r = 0.19; P = .08). Mitral regurgitation affects the majority of Doppler param eters widely used to predict filling pressure but does not influence Ad'-Ad , which proved to be the strongest predictor of left ventricular end-diasto lic pressure.