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It is therefore advantageous to assess LV filling pressures in these cases in an attempt to prove or refute a cardiac cause for the shortness of breath. Similarly, patients with pulmonary disease and significant chronic MR but with cardiac compensation may have dyspnea because of a pulmonary rather than a cardiac cause. Accordingly, both measurements can result in an underestimation of the severity of MS. For example, patients with both significant MS and increased left ventricular (LV) stiffness can have a lower MV gradient (because of increased LV diastolic pressures) and a shorter pressure half-time (because of increased LV stiffness). However, in a number of patients with either mitral regurgitation (MR) or stenosis (MS), questions arise about the impact of MVD on the presenting symptoms. A similar correlation was noted in 13 patients with atrial fibrillation ( r=−0.92, P<0.01) and in a prospective group of 14 patients with MR ( r=−0.93, P<0.001).Ĭonclusions- The ratio of IVRT to T E−Ea or to τ can be readily applied for estimating mean PCWP in patients with MVD and can track changes in PCWP after valve surgery.ĭoppler echocardiography plays a critical role in the management of patients with mitral valve disease (MVD) with respect to both diagnosis and prognosis. In 54 repeat studies, including those performed after MV repair or replacement, these ratios tracked well the changes in PCWP and readily identified changes in mean PCWP by ≥5 mm Hg. The ratio of IVRT to T E−Ea (for MR, r=−0.92 for MS, r=−0.88 both P<0.001) and the ratio of IVRT to τ (for MR, r=−0.74 for MS, r=−0.85 both P<0.001) had the best correlations with PCWP. Among several Doppler measurements, only the mitral E/A ratio, isovolumetric relaxation time (IVRT), and pulmonary venous Ar duration had significant relations with mean pulmonary capillary wedge pressure (PCWP). Methods and Results- Two-dimensional Doppler and TDI echocardiography were performed simultaneously with right-heart catheterization in 51 consecutive patients (mean±SD age, 64☑1 years) with MVD: 35 with moderately severe to severe mitral regurgitation (MR) and 16 with moderate to severe mitral stenosis (MS). We therefore undertook this study to test its usefulness in a patient population. However, the time interval between the onset of early diastolic mitral inflow velocity (E) and annular early diastolic velocity (Ea) by tissue Doppler imaging (TDI), T E−Ea, which is well related to the time constant of LV relaxation (τ) in canine and clinical studies, is not subject to these variables. Customer Service and Ordering Informationīackground- Conventional Doppler measurements have limitations in the prediction of left atrial pressure (LAP) in patients with mitral valve disease (MVD), given the confounding effect of valve area, left ventricular (LV) relaxation, and stiffness.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).