Intensity of murmurs correlates with severity of valvular regurgitation

Desjardins, Valerie A.; Enríquez-Sarano, Maurice; Tajik, A. Jamil; Bailey, Kent R.; Seward, James B.

doi:10.1016/s0002-9343(97)89452-1

Cited by 104 publications

(47 citation statements)

References 38 publications

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“…However, this study's findings allow supposing that sequential measurements over time may help in patient management. The studies published 15,16 and the contribution of this study…”

Section: Discussionmentioning

confidence: 92%

“…Patients with mitral regurgitation can be classified as having mild, moderate, and severe lesions by using clinical history, physical examination, chest teleradiography, and electrocardiography. Frequently, an intense systolic murmur 15 or the presence of a third cardiac sound in the mitral area suggests severe mitral regurgitation 16 . However, this quantification is not perfect due to several interferences.…”

Section: Discussionmentioning

confidence: 99%

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Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos

Meneghelo¹,

Magalhães²,

Ramos³

et al. 2004

Arq. Bras. Cardiol.

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ObjectiveTo assess the sensitivity and specificity of B-type natriuretic peptide (BNP) for identifying symptomatic and asymptomatic patients with severe chronic mitral regurgitation followed up on an outpatient care basis. Methods A group of patients with mitral regurgitation underwent electrocardiography, chest teleradiography, venous blood withdrawal, and transthoracic echocardiography. Based on an analysis of the echocardiographic variables, 62 patients had mild and moderate mitral regurgitation (GI) and 34 had severe mitral regurgitation (GII). The discriminating capacity of the BNP for detecting patients with severe mitral regurgitation was assessed by use of ROC curves. ResultsThe patients' ages ranged from 15 to 63 (mean, 31.7) ConclusionThe BNP values capable of identifying asymptomatic and symptomatic patients with severe mitral regurgitation are lower than 100 pg/mL, which is considered for the diagnosis of heart failure. Key words mitral regurgitation, natriuretic peptides, BNPThe measurement of B-type natriuretic peptide (or brain natriuretic peptide, BNP) levels has been used for diagnosing congestive heart failure, especially when the symptoms and signs are discrete or mild, and in the presence of associated comorbidities, such as pulmonary disease or obesity 1 . The BNP levels have a positive correlation with left ventricular end-diastolic pressure and an inverse correlation with left ventricular function. These concentrations are considered to represent an independent evaluation of ventricular function, with no need for other more expensive tests 2 . The cutoff point of the BNP levels recommended for separating the population with heart failure from that without that syndrome is 100 pg/mL 3 . These initial findings suggest the possibility of expanding the application of BNP level measurement to other situations that gradually lead to left ventricular dysfunction, such as some valvular diseases and congenital heart diseases. The BNP levels in patients with mitral regurgitation are greater than those in controls. The study by Brookes et al 4 showed that 89% of the 22 patients with mitral regurgitation have more elevated BNP levels than healthy individuals do, 20.85 ± 16.9 versus 3.37 ± 0.9 pmol/L. Another study 5 with symptomatic and asymptomatic patients showed that the BNP levels increased according to the severity of mitral regurgitation and were greater in symptomatic patients. However, the case series of these reports are small, and the authors of both studies suggested additional investigation. The objective of the present study was to assess in a group of patients with chronic mitral regurgitation of different degrees, which is the BNP cutoff point capable of identifying the existence of severe mitral regurgitation with or without symptoms. MethodsThe study comprised patients from the valvular heart disease outpatient clinic of our institution diagnosed with chronic mitral regurgitation and who agreed to participate in the study. The diagnosis was based on physical examination due to the ...

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“…However, this study's findings allow supposing that sequential measurements over time may help in patient management. The studies published 15,16 and the contribution of this study…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos

Meneghelo¹,

Magalhães²,

Ramos³

et al. 2004

Arq. Bras. Cardiol.

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“…24 A murmur on examination can be useful, especially for organic MR. However, the intensity of the murmur is lower and correlates poorly with the degree of regurgitation in ischemic MR. 25 Given that the sensitivity in detecting MR at bedside examination is highly variable, especially for a patient presenting with respiratory distress, the key examination remains bedside transthoracic echocardiography. Transesophageal echocardiography can also be useful in determining the severity and mechanism of MR and in documenting the differential pressure between the right and left pulmonary veins.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

et al. 2010

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Background-Cardiogenic unilateral pulmonary edema (UPE) is a rare entity, frequently leading to initial misdiagnosis.We sought to assess the prevalence of UPE and to determine its impact on prognosis compared with bilateral pulmonary edema. Methods and Results-We studied the characteristics and outcomes of patients admitted to our institution for cardiogenic pulmonary edema during an 8-year period. The study population included 869 consecutive patients. The prevalence of UPE was 2.1%: 16 right-sided UPE (89%) and 2 left-sided UPE (11%). In patients with UPE, blood pressure was significantly lower (PՅ0.01), whereas noninvasive or invasive ventilation and catecholamines were used more frequently (Pϭ0.0004 and PϽ0.0001, respectively). The prevalence of severe mitral regurgitation in patients with bilateral pulmonary edema and UPE was 6% and 100%, respectively (PϽ0.0001). In patients with UPE, use of antibiotic therapy and delay in treatment were significantly higher (PϽ0.0001 and Pϭ0.003, respectively). In-hospital mortality was 9%: 39% for UPE versus 8% for bilateral pulmonary edema (odds ratio, 6.9; 95% confidence interval, 2.6 to 18; PϽ0.001). In multivariate analysis, unilateral location of pulmonary edema was independently related to death whatever the model used (adjusted odds ratio, 6.5; 95% confidence interval, 1.3 to 32; Pϭ0.021 for model A; and adjusted odds ratio, 6.8; 95% confidence interval, 1.1 to 41; Pϭ0.037 for model B). Conclusions-Unilateral pulmonary edema represented 2.1% of cardiogenic pulmonary edema in our study, usually appeared as an opacity involving the right lung, and was always associated with severe mitral regurgitation. Unilateral pulmonary edema is related to an independent increased risk of mortality and should be promptly recognized to avoid delays in treatment. (Circulation. 2010;122:1109-1115.)

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“…У них же при аус-культации сердца систолический шум на верхушке вы-слушивался только в 61% случаев. Последнее объ-ясняется последствиями сниженной функции ЛЖ, при-водящей к уменьшению атриовентрикулярного градиента, потоку регургитации и, следовательно, уменьшению ин-тенсивности шума [14,27]. Необходимо принимать во вни-мание, что выслушиваемый на верхушке систолический шум обладает небольшой диагностической ценностью в плане наличия МР.…”

Section: Effect Of Mitral Regurgitation On Chronic Heart Failure Courunclassified

Effect of Mitral Regurgitation on Chronic Heart Failure Course and Structure-Functional Heart State

Ларина

Барт

Mikhaylusova

et al. 2009

Racionalʹnaâ farmakoterapiâ v kardiologii

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Среди факторов, способствующих декомпенсации и прогрессированию хронической сердечной недостаточ-ности (ХСН), важное клиническое значение имеет со-путствующая митральная регургитация (МР). Функцио-нальная полноценность митрального клапана зависит от координированного взаимодействия атриовентрику-лярного кольца, створок клапана, хорд, папиллярных мышц, левого предсердия и левого желудочка (ЛЖ). Это взаимодействие определяют как «клапанно-желудоч-ковый комплекс». Нормальная геометрия ЛЖ, функцио-нирование папиллярных мышц и хорд способствует нор-мальному соприкосновению створок и предотвращает воз-никновение обратного тока крови во время систолы же-лудочков. Дисфункция одного или более компонентов дан-ного комплекса может приводить к развитию МР [1]. Ос-новными причинами являются ишемическая болезнь сердца (с развитием ишемической МР), дилатационная кардиомиопатия (с развитием функциональной МР), ревматическое поражение клапанов, инфекционный эн-Mitral regurgitation (MR) is one of the factors contributory to chronic heart failure (CHF) decompensation and progress, that is why it has great clinical importance. Functional competence of mitral valve depends on coordinated interaction of such structures as atrioventricular ring, valve leaflets, chords, papillary muscles, left atrium and left ventricle (LV). This interaction is known as "valve-ventricular complex". Normal LV geometry, papillary muscles and chords correct functioning ensure adequate leaflets contiguity and prevent regurgitation during ventricle systole. Dysfunction of one or more components can lead to MR development [1]. Main reasons of such dysfunction are: ischemic heart disease (with ischemic MR development), dilated cardiomyopathy (with functional MR development), rheumatic valve lesion, infective endocarditis, myxomatous change (in congenital diseases with dysplasia and damage of mitral valve connective tissue) and some other states.Different lesions of mitral valve apparatus lead to MR development. MR can be registered with normal leafs move- Aim. To evaluate chronic heart failure (CHF) course, functional and structural heart changes in patients with functional mitral regurgitation (MR) of various degrees. Material and methods. A total of 104 outpatients (60-85 y. o.) with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups. Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV) systolic dysfunction (p=0,029), severe CHF course (p=0,034), received furosemide (p=0.004) and digoxin (p=0,004). They had significant increase in end-diastolic dimension (p<0,001), end-systolic dimension (p<0,001), left atrium (p=0,004), end-diastolic volume (p<0,001), end-systolic volume (p<0,001), pulmonary artery pressure (p<0,001), decrease in LV rel...

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Intensity of murmurs correlates with severity of valvular regurgitation

Cited by 104 publications

References 38 publications

Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos

Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos

Prevalence, Characteristics, and Outcomes of Patients Presenting With Cardiogenic Unilateral Pulmonary Edema

Effect of Mitral Regurgitation on Chronic Heart Failure Course and Structure-Functional Heart State

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