Doppler mitral pressure half-time: a clinical tool in search of theoretical justification

Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Boston 02114.

The Doppler determination of the mitral pressure half-time has gained widespread acceptance as a reliable estimate for mitral valve area, despite little theoretical basis for its "independence" of other hemodynamic variables. A simple model of the left atrium and mitral valve has been developed and a governing equation derived from fluid dynamics fundamentals. Solution of this equation indicates that the pressure half-time should vary inversely with mitral valve area, but also proportionally to net left atrial and ventricular compliance and to the square root of the peak transmitral gradient. This complex relation is apparently masked in the typical clinical situation because pressure and compliance tend to change in opposite directions, thereby partly offsetting each other. In several clinical settings, such as balloon mitral valvotomy, left ventricular hypertrophy and aortic regurgitation, changes in initial pressure and compliance may be large enough to alter the relation between mitral area and pressure half-time. This study reviews the development of the pressure half-time concept, presents an overall method for studying mitral valve flow using mathematical modeling and describes the effects of factors other than mitral valve area on pressure half-time.

This article has been cited by other articles:

				A. Germing, M. Bechtel, and A. Mugge Do Not Confuse the Edge-to-Edge Technique With Mitral Valve Stenosis: Methodological Considerations for Echocardiography After Mitral Valve Repair J. Ultrasound Med., August 1, 2011; 30(8): 1156 - 1157. [Full Text] [PDF]

				A. M. Salem Omar, H. Tanaka, T. K. AbdelDayem, A. S. Sadek, H. Raslaan, A. Al-Sherbiny, K. Yamawaki, K. Ryo, Y. Fukuda, K. Norisada, et al. 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 Eur Heart J Cardiovasc Imaging, April 1, 2011; 12(4): 283 - 290. [Abstract] [Full Text] [PDF]

				H. Baumgartner, J. Hung, J. Bermejo, J. B. Chambers, A. Evangelista, B. P. Griffin, B. Iung, C. M. Otto, P. A. Pellikka, and M. Quinones Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice Eur Heart J Cardiovasc Imaging, January 1, 2009; 10(1): 1 - 25. [Full Text] [PDF]

				B. Jungwirth and G. B. Mackensen Real-Time 3-Dimensional Echocardiography in the Operating Room Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2008; 12(4): 248 - 264. [Abstract] [PDF]

				J. D. Thomas and Z. B. Popovic Assessment of Left Ventricular Function by Cardiac Ultrasound J. Am. Coll. Cardiol., November 21, 2006; 48(10): 2012 - 2025. [Abstract] [Full Text] [PDF]

				A. D. Waggoner Quantitative Echocardiography Journal of Diagnostic Medical Sonography, November 1, 2005; 21(6): 464 - 470. [Abstract] [PDF]

				G. R. Rezaian, K. Aghasadeghi, and J. Kojuri Evaluation of the Hemodynamic Performance of St.Jude Mitral Prostheses: A Pilot Study by Dobutamine-Stress Doppler Echocardiography Angiology, January 1, 2005; 56(1): 81 - 86. [Abstract] [PDF]

				E. Schwammenthal, Z. Vered, O. Agranat, E. Kaplinsky, B. Rabinowitz, and M. S. Feinberg Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis : An Exercise Echocardiographic Study Circulation, November 7, 2000; 102(19): 2378 - 2384. [Abstract] [Full Text] [PDF]

				T. M. Binder, R. Rosenhek, G. Porenta, G. Maurer, and H. Baumgartner Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1355 - 1361. [Abstract] [Full Text] [PDF]

				S F de Marchi, S Windecker, B C Aeschbacher, and C Seiler Influence of left ventricular relaxation on the pressure half time of aortic regurgitation Heart, November 1, 1999; 82(5): 607 - 613. [Abstract] [Full Text]

				R. Taylor Assessing Mitral Stenosis with Doppler Echocardiography: Limitations of the Pressure Half-Time Method Journal of Diagnostic Medical Sonography, July 1, 1990; 6(4): 219 - 223. [Abstract] [PDF]