Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis: Clinical evidence, in vitro simulation and theoretic analysis

Frank A. Flachskampf, Arthur E. Weyman, Linda Gillam, Liu Chun-Ming, Vivian M. Abascal, James D. Thomas

Research output: Contribution to journalArticle

82 Citations (Scopus)

Abstract

Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p < 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T 1 2 (r = 0.77) as compared with a best fit of 195/T 1 2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.

Original languageEnglish (US)
Pages (from-to)396-404
Number of pages9
JournalJournal of the American College of Cardiology
Volume16
Issue number2
DOIs
StatePublished - Jan 1 1990
Externally publishedYes

Fingerprint

Aortic Valve Insufficiency
Mitral Valve Stenosis
Pressure
Mitral Valve
Compliance
In Vitro Techniques
Mathematics
Color

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Flachskampf, Frank A. ; Weyman, Arthur E. ; Gillam, Linda ; Chun-Ming, Liu ; Abascal, Vivian M. ; Thomas, James D. / Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis : Clinical evidence, in vitro simulation and theoretic analysis. In: Journal of the American College of Cardiology. 1990 ; Vol. 16, No. 2. pp. 396-404.
@article{7d65be50e7504bfbb6848c40b8bcfc82,
title = "Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis: Clinical evidence, in vitro simulation and theoretic analysis",
abstract = "Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p < 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T 1 2 (r = 0.77) as compared with a best fit of 195/T 1 2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.",
author = "Flachskampf, {Frank A.} and Weyman, {Arthur E.} and Linda Gillam and Liu Chun-Ming and Abascal, {Vivian M.} and Thomas, {James D.}",
year = "1990",
month = "1",
day = "1",
doi = "10.1016/0735-1097(90)90592-D",
language = "English (US)",
volume = "16",
pages = "396--404",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "2",

}

Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis : Clinical evidence, in vitro simulation and theoretic analysis. / Flachskampf, Frank A.; Weyman, Arthur E.; Gillam, Linda; Chun-Ming, Liu; Abascal, Vivian M.; Thomas, James D.

In: Journal of the American College of Cardiology, Vol. 16, No. 2, 01.01.1990, p. 396-404.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Aortic regurgitation shortens Doppler pressure half-time in mitral stenosis

T2 - Clinical evidence, in vitro simulation and theoretic analysis

AU - Flachskampf, Frank A.

AU - Weyman, Arthur E.

AU - Gillam, Linda

AU - Chun-Ming, Liu

AU - Abascal, Vivian M.

AU - Thomas, James D.

PY - 1990/1/1

Y1 - 1990/1/1

N2 - Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p < 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T 1 2 (r = 0.77) as compared with a best fit of 195/T 1 2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.

AB - Mitral valve areas determined by Doppler pressure half-time were compared with areas obtained by planimetry in two groups of patients with mitral stenosis: 24 patients without aortic regurgitation and 32 patients with more than grade 1 aortic regurgitation. The severity of aortic regurgitation was assessed by color flow mapping; 17 patients had grade 2, 10 had grade 3 and 5 had grade 4 aortic regurgitation. Regression equations for pressure half-time area versus planimetry mitral valve area were calculated separately for the aortic regurgitation (r = 0.88) and the nonaortic regurgitation group (r = 0.86); analysis of covariance revealed a significant (p < 0.001) difference between the two groups leading to overestimation of planimetry area by the pressure half-time method in the aortic regurgitation group. The mitral valve areas in the group without regurgitation were best calculated with the expression 239/T 1 2 (r = 0.77) as compared with a best fit of 195/T 1 2 (r = 0.85) for the aortic regurgitation group. To elucidate the mechanisms affecting pressure half-time in aortic regurgitation, an in vitro model of mitral inflow in the presence of varying regurgitant volumes and different ventricular chamber compliances was used. Aortic regurgitation shortened directly measured pressure half-time proportional to the regurgitant fraction but an increase in left ventricular compliance could offset this effect. Finally, in a mathematic model of mitral inflow the competing effects of aortic regurgitation and chamber compliance could be confirmed. In conclusion, aortic regurgitation results clinically in a significant net shortening of pressure half-time leading to mitral valve area overestimation. However, the effect is moderate and individually unpredictable because of changes in chamber compliance.

UR - http://www.scopus.com/inward/record.url?scp=0025029948&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025029948&partnerID=8YFLogxK

U2 - 10.1016/0735-1097(90)90592-D

DO - 10.1016/0735-1097(90)90592-D

M3 - Article

C2 - 2373818

AN - SCOPUS:0025029948

VL - 16

SP - 396

EP - 404

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 2

ER -