Abstract n°46 - LEFT ATRIAL VOLUME AND LEFT VENTRICULAR DIASTOLIC PARAMETERS PREDICT PULMONARY ARTERY PRESSURE LEVEL IN MITRAL REGURGITATION RELATED TO VALVE PROLAPSE - 09/04/08
T Le Tourneau,
S Pouwels,
C Vanesson,
E Cuvelier,
F Biausque,
AS Polge,
O Dascotte,
N Lamblin,
C Bauters,
G Deklunder
Voir les affiliationsPurpose: Mitral valve surgery is recommended in patients with organic mitral regurgitation (MR) and severe pulmonary artery pressure (PAP > = 50 mmHg) at rest. However little is known about the determinants of PAP in this setting. Therefore, we sought to evaluate the predictive factors of systolic PAP in MR due to mitral valve prolapse.
Methods: One hundred forty-two patients (61 ± 12 years, 102 males) with moderate to severe MR related to valve prolapse underwent a complete echocardiographic examination with pulmonary artery pressure measurement (using tricuspid regurgitation) and mitral tissue doppler imaging (TDI).
Results: Mean systolic PAP was 44 ± 13 mmHg, ranging from 25 to 105 mmHg. Patients with a systolic PAP > = 50 mmHg (n = 41) were older and more symptomatic, had a more severe MR and a higher heart rate, a greater left atrium volume, a higher mitral E wave and E/A ratio, a shorter mitral deceleration time, a higher mitral E/Ea ratio and a lower aortic stroke volume. In univariate analysis, echocardiographic predictive factors of systolic PAP were MR grade (r = 0.31, p < 0.0001), left atrial volume/m2 (r = 0.37, p < 0.0001), mitral E velocity (r = 0.49, p < 0.0001), mitral E/A ratio (r = 0.47, p < 0.0001), mitral deceleration time (r =-0.40, p < 0.0001), septal mitral E/Ea ratio (r = 0.47, p < 0.0001), and aortic stroke volume (r =-0.29, p = 0.0006). In multivariate analysis, the strongest independent factor associated with systolic PAP was septal mitral E/Ea ratio (p = 0.0006); other independent factors were left atrial volume/m2 (p = 0.002) and mitral deceleration time (p = 0.0008). Left ventricular size or ejection fraction, as well as effective regurgitant orifice or regurgitant volume were not predictive of systolic pulmonary artery pressure. Moreover a septal E/Ea ratio > = 16 had a sensitivity of 70%, a specificity of 63%, and an accuracy of 77% in predicting a systolic PAP > = 50 mmHg.
Conclusion: In moderate to severe organic mitral regurgitation related to mitral valve prolapse, systolic PAP is not associated with left ventricular size or function, but is strongly associated with a parameter of diastolic function (mitral E/Ea ratio); mitral E/Ea ratio > = 16 can be used as a surrogate of systolic PAP > = 50 mmHg.
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© 2007 Elsevier Masson SAS. Tous droits réservés.
Vol 100 - N° 12
P. 1083-1084 - décembre 2007 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.