Effect of Mitral Inflow Pattern on Diagnosis of Severe Mitral Regurgitation in Patients with Chronic Organic Mitral Regurgitation.
10.4250/jcu.2013.21.4.165
- Author:
Nishath QUADER
1
;
Prasanth KATTA
;
Mohammad Q NAJIB
;
Hari P CHALIKI
Author Information
1. Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ, USA. chaliki.hari@mayo.edu
- Publication Type:Original Article
- Keywords:
A wave velocity;
Diastolic function;
E wave velocity;
Severe mitral regurgitation
- MeSH:
Aortic Valve Insufficiency;
Atrial Fibrillation;
Diagnosis*;
Echocardiography;
Humans;
Mitral Valve Insufficiency*;
Prevalence;
Sensitivity and Specificity;
Stroke Volume
- From:Journal of Cardiovascular Ultrasound
2013;21(4):165-170
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: To determine sensitivity and specificity of E wave velocity in patients with severe chronic organic mitral regurgitation (MR) and normal left ventricular ejection fraction (EF) and to evaluate prevalence of A wave dominance in patients with severe MR. METHODS: We compared 35 patients with quantified severe, chronic, quantified, organic MR due to flail/prolapsed leaflets who had reparative surgery with 35 age-matched control subjects. Exclusion criteria: EF < 60%, atrial fibrillation, and more than mild aortic regurgitation. RESULTS: Mean [standard deviation (SD)] age [70 (8) years vs. 69 (8) years; p = 0.94] and mean (SD) EF [66% (6%) vs. 65% (4%); p = 0.43] were not different between the two groups. Mean (SD) E wave velocity was greater in case patients than control subjects [1.2 (0.3) m/sec vs. 0.7 (0.15) m/sec; p < 0.001]. However, E wave velocity of 1.2 m/sec had a sensitivity of only 57% [95% confidence interval (CI), 41-7 and a specificity of 100% (95% CI, 90-100%) in identifying severe MR. E wave velocity of 0.9 m/sec had a more optimal combined sensitivity (89%; 95% CI, 74-95%) and specificity (86%; 95% CI, 71-94%). A wave dominance was seen in 18% of case patients and 66% of control subjects (p < 0.001). CONCLUSION: E wave velocity of 1.2 m/sec is specific not sensitive for severe organic MR; E wave velocity of 0.9 m/sec has better sensitivity and specificity. A wave dominance pattern alone cannot exclude patients with severe organic MR. Our findings highlight the importance of a comprehensive echocardiographic exam rather than relying on a few Doppler parameters in diagnosing MR.
