CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 1, January/February 2014
38
AFRICA
with MVD was inaccurate in our study.
Previous studies have shown that there is a correlation
between pulmonary vein parameters and LAP in patients with
mitral stenosis. In one study, among the variables of PV flow,
the systolic fraction (i.e. the systolic velocity–time integral,
expressed as a fraction of the sum of systolic and early diastolic
velocity–time integral) correlated significantly with mean LAP
(
r
=
–0.71,
p
<
0.05) and mitral valve area (
r
=
0.64,
p
<
0.05).
Peak velocity and the velocity–time integral in systole also
significantly correlated with mean LAP (
r
=
–0.66,
r
=
–0.67
respectively,
p
<
0.05).
18
In our study, the relationship of PVs/PVs
+
PVd with mean
LAP reached the level of statistical significance. However, the
relationship was weak. There was no relationship between this
ratio and LVEDP. It is possible that because PVs/PVs
+
PVd
relates best to mean LAP, we observed no correlations between
this ratio and late diastolic LV pressures.
With regard to TDI velocities, our observation was similar
to previous studies.
16,19
Ea velocity was reduced in patients with
MS, despite a normal EF, and improved the predictive model of
LVEDP. It also played a role in discriminate models to predict
LVEDP
>
15 mmHg.
The accuracy of E/Ea for estimating LV filling pressure
appeared to be better in patients with depressed LVEF (
<
50%)
than in patients with preserved LVEF (
≥
50%).
6
This ratio (E/Ea)
did not improve the prediction of LVEDP in our patients. This
may have been because of the presence of a normal LVEF in
most of our patients, and confirms an important limitation in
using E/Ea in patients with significant MVD.
16
IVRT has been used for decades in the clinical evaluation
of patients with MS, being shorter in patients with more severe
MS. LV relaxation also influences IVRT.
16
All of these make the
interpretation of the relationship between IVRT and LVEDP
complicated. In our study, although there was no significant
correlation between IVRT and LVEDP, this time interval could
improve discriminate models to predict LVEDP
>
15 mmHg.
Although some previous studies showed strong relationships
between the time interval TE–Ea and LV relaxation,
11
and used
this time interval in order to correct for the effect of LV relaxation
on IVRT,
16
we did not observe any relationship between IVRT/
TE–Ea ratio and LV filling pressure in patients with MS.
Previous studies have established the value of left atrial size
for the prediction of heart failure with both depressed
5,20
and
preserved left ventricular systolic function.
21
In this study the
LAA improved the prediction of LV filling pressure in patients
with MS and also remained in the discriminate model to estimate
LVEDP
>
15 mmHg.
There were several limitations to this study. First, there were
few patients with MS and LV systolic dysfunction or a depressed
EF. Also older patients and those with other cardiovascular
diseases (coronary artery disease, hypertension and diabetes
mellitus) were absent in our study. There were only six patients
with AF in this study. Therefore, we were limited in extrapolating
conclusions to these particular subgroups.
Second, in order to obtain meaningful results, a strict and
time-consuming methodology must be used, which may limit the
everyday application of this method in a busy clinical practice.
Therefore the results of our study could be applied in equivocal
cases where conventional echocardiography is not matched with
the patient’s symptoms.
Conclusion
Despite these limitations, our results provide evidence that, in
patients with mitral stenosis, LV filling pressure can be estimated
by combining Doppler echocardiographic variables of mitral
flow. However, more studies are required to confirm these
results. Doppler echocardiography, a simple, readily available,
non-invasive tool, may in future reduce the need for right heart
catheterisation in patients with mitral stenosis and unexplained
symptoms.
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