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CLINICAL STUDY: CARIOVASCULAR ULTRASOUND STUDIES

Is the mitral valve area flow-dependent in mitral stenosis?

A dobutamine stress echocardiographic study

Jagdish C. Mohan, MD^*, Ayan R. Patel, MD, FACC, Rajiv Passey, MD^*, Dinesh Gupta, MD^*, Manoj Kumar, MD^*, Ramesh Arora, MD^* and Natesa G. Pandian, MD, FACC^,*

^* Department of Cardiology, G. B. Pant Hospital, New Delhi, India
Cardiovascular Imaging and Hemodynamic Laboratory, Tufts-New England Medical Center, Boston, Massachusetts, USA

Manuscript received May 30, 2002; revised manuscript received July 12, 2002, accepted August 1, 2002.

^* Reprint requests and correspondence: Dr. Natesa G. Pandian, Cardiovascular Imaging and Hemodynamic Laboratory, Tufts-New England Medical Center, 750 Washington Street, Box 32, Boston, Massachusetts 02111, USA.
npandian{at}lifespan.org

OBJECTIVES: The purpose of this study was to compare the effect of changes in flow rate on the mitral valve area (MVA) derived from two-dimensional echocardiographic planimetry and Doppler pressure half-time (PHT) methods in patients with mitral stenosis (MS).

BACKGROUND: Dobutamine stress echocardiography has been proposed as a means of assessing the severity of MS. However, data regarding the effect of an increase in flow rate on MVA are limited. If MVA is indeed flow-dependent, this has important implications for the assessment of the severity of MS, particularly in the setting of reduced cardiac output (CO).

METHODS: Dobutamine echocardiography was performed in 57 patients with isolated MS who were in sinus rhythm. The MVA was determined by planimetry and Doppler PHT methods.

RESULTS: Cardiac output increased by 50% in 27 patients (group I) and by <50% in 30 patients (group II). In group I, the MVA by planimetry increased by only 10.6 ± 2% and the MVA by PHT increased by 21.9 ± 4.8%. These changes were similar to those observed in group II (10.7 ± 3% and 14.8 ± 4%, respectively; p = NS), despite a much smaller increase in CO. A clinically important change (from the severe to mild category) occurred in only one patient when using the PHT method and in none by planimetry.

CONCLUSIONS: Changes in flow rate result in small but clinically insignificant changes in echocardiographic MVA measurement. These methods provide an accurate assessment of MS severity in a majority of patients, independent of changes in flow rate.

Abbreviations and Acronyms   CO   cardiac output   HR   heart rate   LVOT   left ventricular outflow tract   MS   mitral stenosis   MVA   mitral valve area   PHT   pressure half-time   PHT-MVA   mitral valve area measured by pressure half-time   2DE-MVA   mitral valve area measured by two-dimensional echocardiography

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