Usefulness of peak mitral inflow velocity to predict severe mitral regurgitation in patients with normal or impaired left ventricular systolic function

Background The aim of this study was to evaluate the reliability of peak mi tral inflow (E-wave) velocity, which was thought to be easier and more prac tical than qualitative and quantitative methods used to grade mitral regurg itation (MR) in patients both with normal and low left ventricular (LV) eje ction fraction (EF). It is known that peak E-wave velocity increases in MR. But correlation of this increase with regurgitant fraction (RF), its usefu lness in grading MR, and the effect of EF on peak E-wave velocity have not been studied in detail. Methods We prospectively examined 135 consecutive patients with varying gra des of MR with echocardiography. MR was evaluated both qualitatively and qu antitatively, and concordance of these 2 methods was determined. Peak E-wav e velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. LV isovolumetric relaxation and contraction times were measured. Different MR groups classified by RF were compared wit h each other. Results Concordance of quantitative and qualitative evaluation was low in p atients with low EF (kappa 0.37 vs 0.65). Peak E-wave velocity and E/A rati o showed significant differences between MR groups. Peak E-wave velocity co rrelated with the RF and EF (r = 0.47, r = 0.33, respectively, P < .001). S ensitivity, specificity, and negative predictive value of peak E-wave veloc ity > 1.2 m/s suggesting severe MR were found to be different in patients w ith normal and low EF (96% vs 66%, 78% vs 83%, 97% vs 78%, respectively). E -wave deceleration, LV isovolumetric relaxation, and contraction time did n ot show a correlation with RF. Conclusion Peak E-wave velocity is a screening method that could be used in common for determining severity of MR semiquantitatively, especially in pa tients with normal EF.