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MITRAL VALVE INDEX: A SIMPLE AND ROBUST PARAMETER FOR DETECTING PROSTHETIC MITRAL VALVE REGURGITATION
A1331 JACC March 17, 2015 Volume 65, Issue 10S
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) Mitral Valve Index: A Simple and Robust Parameter for Detecting Prosthetic Mitral Valve Regurgitation Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m. Session Title: Non Invasive Imaging: Advances in Clinical Non-Invasive Imaging Abstract Category: 17. Non Invasive Imaging: Echo Presentation Number: 1243-043 Authors: Sushil Allen Luis, Lori Blauwet, Ramila Mehta, Himabindu Samardhi, Cathy West, Chris Luis, Gregory Scalia, Fletcher Miller, Darryl Burstow, Mayo Clinic, Rochester, MN, USA, The Prince Charles Hospital, Brisbane, Australia
Background: Assessment of prosthetic mitral regurgitation (PMR) by transthoracic echocardiography (TTE) poses technical challenges due to acoustic shadowing. The ratio of mitral prosthetic to LVOT TVI (mitral valve index) has previously been demonstrated, in a small patient cohort, to be useful in identifying mechanical mitral prostheses with significant regurgitation. We aimed to assess the utility of this index for the detection of PMR in a large cohort of mechanical and bioprosthetic valves.
Methods: Retrospective TTE assessment of mitral prostheses was performed. All prostheses underwent transesophageal echocardiography (TEE) within 30 days of TTE. Mitral regurgitation was defined by TEE and classified according to severity.
Results: Of the 1054 prostheses included, 689 were mechanical (651 bileaflet, 37 tilting disk and 1 unclassified) and 365 were tissue (293 porcine, 56 pericardial and 16 unclassified). Mean heart rate for the entire cohort was 77 ± 15 bpm. Cardiac rhythm at time of TTE was sinus rhythm in 58%, an atrial arrhythmia in 33%, and paced in 9%. Mean left ventricular ejection fraction was 54% ± 14%. Additional study results are as displayed in the table. Echocardiographic Parameters of Mitral Valve Prostheses According to Mitral Regurgitation Severity
MG, mmHg E velocity, m/s PHT, ms TVIMVP, cm Mitral valve index
No/ Trivial MR N=655
Mild/ MildModerate MR N=185
Moderate MR N=59
Moderate-Severe MR N=56
Severe MR N=99
P value
5.9±2.3 1.87±0.38 77.6±23.6 40.8±11.2 1.97±0.49
5.9±2.2 1.95±0.41 72.3±18.0 42.5±10.7 1.93±0.43
7.1±2.6 2.06±0.40 81.9±21.5 49.6±14.6 2.42±0.80
7.5±3.2 2.24±0.36 79.6±19.4 50.9±14.3 2.48±0.49
8.7±3.4 2.40±0.37 76.5±18.4 55.9±14.5 2.78±.71
<0.0001 <0.0001 NS <0.0001 <0.0001
Abbreviations: E velocity, peak early diastolic mitral inflow velocity; MG, mean gradient; MR, mitral regurgitation; NS, not significant; PHT, pressure half-time, TVIMVP, time velocity integral of the mitral valve prosthesis; MVR Index, ratio of the time velocity integral of the mitral valve prosthesis to the time velocity integral of the left ventricular outflow tract Data are expressed as mean ± SD. Conclusion: In this large study cohort, mitral valve index was significantly elevated in patients with significant PMR. This index, in combination with normal pressure half-time and increased E-velocity and mean gradient, provides improved diagnostic yield for PMR by TTE, allowing more appropriate patient selection for TEE evaluation.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) Mitral Valve Index: A Simple and Robust Parameter for Detecting Prosthetic Mitral Valve Regurgitation Poster Contributions Poster Hall B1 Monday, March 16, 2015, 9:45 a.m.-10:30 a.m. Session Title: Non Invasive Imaging: Advances in Clinical Non-Invasive Imaging Abstract Category: 17. Non Invasive Imaging: Echo Presentation Number: 1243-043 Authors: Sushil Allen Luis, Lori Blauwet, Ramila Mehta, Himabindu Samardhi, Cathy West, Chris Luis, Gregory Scalia, Fletcher Miller, Darryl Burstow, Mayo Clinic, Rochester, MN, USA, The Prince Charles Hospital, Brisbane, Australia
Background: Assessment of prosthetic mitral regurgitation (PMR) by transthoracic echocardiography (TTE) poses technical challenges due to acoustic shadowing. The ratio of mitral prosthetic to LVOT TVI (mitral valve index) has previously been demonstrated, in a small patient cohort, to be useful in identifying mechanical mitral prostheses with significant regurgitation. We aimed to assess the utility of this index for the detection of PMR in a large cohort of mechanical and bioprosthetic valves.
Methods: Retrospective TTE assessment of mitral prostheses was performed. All prostheses underwent transesophageal echocardiography (TEE) within 30 days of TTE. Mitral regurgitation was defined by TEE and classified according to severity.
Results: Of the 1054 prostheses included, 689 were mechanical (651 bileaflet, 37 tilting disk and 1 unclassified) and 365 were tissue (293 porcine, 56 pericardial and 16 unclassified). Mean heart rate for the entire cohort was 77 ± 15 bpm. Cardiac rhythm at time of TTE was sinus rhythm in 58%, an atrial arrhythmia in 33%, and paced in 9%. Mean left ventricular ejection fraction was 54% ± 14%. Additional study results are as displayed in the table. Echocardiographic Parameters of Mitral Valve Prostheses According to Mitral Regurgitation Severity
MG, mmHg E velocity, m/s PHT, ms TVIMVP, cm Mitral valve index
No/ Trivial MR N=655
Mild/ MildModerate MR N=185
Moderate MR N=59
Moderate-Severe MR N=56
Severe MR N=99
P value
5.9±2.3 1.87±0.38 77.6±23.6 40.8±11.2 1.97±0.49
5.9±2.2 1.95±0.41 72.3±18.0 42.5±10.7 1.93±0.43
7.1±2.6 2.06±0.40 81.9±21.5 49.6±14.6 2.42±0.80
7.5±3.2 2.24±0.36 79.6±19.4 50.9±14.3 2.48±0.49
8.7±3.4 2.40±0.37 76.5±18.4 55.9±14.5 2.78±.71
<0.0001 <0.0001 NS <0.0001 <0.0001
Abbreviations: E velocity, peak early diastolic mitral inflow velocity; MG, mean gradient; MR, mitral regurgitation; NS, not significant; PHT, pressure half-time, TVIMVP, time velocity integral of the mitral valve prosthesis; MVR Index, ratio of the time velocity integral of the mitral valve prosthesis to the time velocity integral of the left ventricular outflow tract Data are expressed as mean ± SD. Conclusion: In this large study cohort, mitral valve index was significantly elevated in patients with significant PMR. This index, in combination with normal pressure half-time and increased E-velocity and mean gradient, provides improved diagnostic yield for PMR by TTE, allowing more appropriate patient selection for TEE evaluation.