Comparison of mitral valve area by pressure half-time and proximal isovelocity surface area method in patients with mitral stenosis: effect of net atrioventricular compliance

Omar, Alaa Mabrouk Salem; Tanaka, Hidekazu; Abdeldayem, T K; Sadek, Ayman S.; Raslaan, Halah; Al-Sherbiny, Ashraf; Yamawaki, Kohei; Ryo, Keiko; Fukuda, Yuko; Norisada, Kazuko; Tatsumi, Kazuhiro; Onishi, Tetsuari; Matsumoto, Kensuke; Kawai, Hiroya; Hirata, Ken–ichi

doi:10.1093/ejechocard/jeq194

Cited by 13 publications

(12 citation statements)

References 30 publications

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“…Pressure half time is routinely utilized to calculate the MVA and has level 1 recommendation for assessment for severity of MS . PHT is dependent on left atrial and left ventricular compliance and can be inaccurate in patients with abnormal compliance . The routinely used equation for MVA (MVA = 220/PHT) as proposed by Hatle et al also has potential pitfalls.…”

Section: Discussionmentioning

confidence: 99%

“…The numerator in the equation “220” is derived from the equation 11.6 × Cn × delta P½. Cn is net atrioventricular compliance, and the assessment of Cn has been described previously . In these studies, it was observed that for patients with abnormal (increased and decreased) atrioventricular compliance (Cn) the correlation of the MVA with PISA method or planimetery was not as good as patients with normal compliance.…”

Section: Discussionmentioning

confidence: 99%

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When the gold standard is not always golden: The value of invasive hemodynamic assessment to overcome the pitfalls of echocardiography in challenging cases of mitral stenosis

et al. 2018

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Mitral stenosis is a uncommon valvular lesion in the developed countries. Noninvasive evaluation is the first-line modality for assessment of mitral stenosis, however the noninvasive methods may have limitations in certain cases. Invasive hemodynamics can be used as adjunct tool for assessment of mitral stenosis in such difficult cases. Mitral valve using three-dimensional planimetry is a promising technique for assessment of mitral stenosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

When the gold standard is not always golden: The value of invasive hemodynamic assessment to overcome the pitfalls of echocardiography in challenging cases of mitral stenosis

et al. 2018

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“…Previous studies have also indicated that C n contributes to determining pulmonary hypertension in MS, 3, 12–14, 17, 25, 29 but had several limitations. Li et al 10 could not find any relation between parameters of MS severity and pulmonary pressure from the small number of patients studied.…”

Section: Discussionmentioning

confidence: 99%

“…C n was determined noninvasively by means of Doppler echocardiography as previously described 9, 12, 14, 17, 25 : C n (mL/mmHg) = 1270 × (planimetric MV area [cm 2 ]/E-wave downslope [cm/s 2 ]). In those patients with nonlinear diastolic flow, the mid-diastolic flow was used, which is felt to best represent the valve stenosis as opposed to early LA depressurization, and the slope was extrapolated back to obtain the initial maximal velocity.…”

Section: Methodsmentioning

confidence: 99%

Impact of Net Atrioventricular Compliance on Clinical Outcome in Mitral Stenosis

Nunes

Hung

Barbosa

et al. 2013

Circ: Cardiovascular Imaging

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Background Net atrioventricular compliance (Cn) has been reported to be an important determinant of pulmonary hypertension in mitral stenosis (MS). We hypothesized that, as Cn reflects hemodynamic consequences of MS, it may be useful in assessing prognosis. To date, limited data with an assumed Cn cutoff have indicated the need for larger prospective studies. This prospective study was designed to determine the impact of Cn on clinical outcome and its contribution to pulmonary pressure in MS. In addition, we aimed to identify a cutoff value of Cn for outcome prediction in this setting. Methods and Results A total of 128 patients with rheumatic MS without other significant valve disease were prospectively enrolled. Comprehensive echocardiography was performed and Doppler-derived Cn estimated using a previously validated equation. The endpoint was either mitral valve intervention or death. Cn was an important predictor of pulmonary pressure, regardless of classic measures of MS severity. During a median follow-up of 22 months, the endpoint was reached in 45 patients (35%). Baseline Cn predicted outcome, adding prognostic information beyond that provided by mitral valve area and functional status. Cn ≤ 4 mL/mmHg best predicted unfavorable outcome in derivation and validation sets. A subgroup analysis including only initially asymptomatic patients with moderate to severe MS without initial indication for intervention (40.6 % of total) demonstrated that baseline Cn predicted subsequent adverse outcome even after adjusting for classic measures of hemodynamic MS severity (hazard ratio [HR] 0.33, 95% confidence interval [CI] 0.14–0.79, p = 0.013). Conclusions Cn contributes to pulmonary hypertension beyond of stenosis severity itself. In a wide spectrum of MS severity, Cn is a powerful predictor of adverse outcome, adding prognostic value to clinical data and mitral valve area. Importantly, baseline Cn predicts a progressive course with subsequent need for intervention in initially asymptomatic patients. Cn assessment therefore has potential value for clinical risk stratification and monitoring in MS patients.

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“…16 Being independent of reference valve flow, PISA is not affected by significant MR or AR. Loading conditions also are less likely to influence the calculations because the acquisition of all formula components can be accomplished in a couple of beats.…”

Section: Quantitative Assessmentmentioning

confidence: 93%

Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography

Cherry

Maxwell

Nicoara

2016

Anesthesia &Amp; Analgesia

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Comparison of mitral valve area by pressure half-time and proximal isovelocity surface area method in patients with mitral stenosis: effect of net atrioventricular compliance

Abstract: MVA calculated with both the PISA and PHT methods correlated well with MVA calculated with the planimetry method. However, the PISA rather than PHT is recommended for patients with MS and extreme C(n) values because PISA, unlike PHT, is not affected by changes in C(n).

Cited by 13 publications

References 30 publications

When the gold standard is not always golden: The value of invasive hemodynamic assessment to overcome the pitfalls of echocardiography in challenging cases of mitral stenosis

When the gold standard is not always golden: The value of invasive hemodynamic assessment to overcome the pitfalls of echocardiography in challenging cases of mitral stenosis

Impact of Net Atrioventricular Compliance on Clinical Outcome in Mitral Stenosis

Intraoperative Evaluation of Mitral Stenosis by Transesophageal Echocardiography

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