P422Mitral regurgitation in aortic stenosis: comparison between quantitative and semiquantitative methods.


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Abstract

Background: Functional mitral regurgitation (MR) from mild (1+) to moderate-severe (3+) grade, is associated with severe aortic stenosis (AS). Although replacement or repair of mitral valve could be considered, MR generally improves after aortic valve replacement. However, the majority of the evidence is based on semiquantitative assessment of MR, which assumes a positive relationship between jet color area (JA) and LV systolic pressure (LVSP).Objetive: To assess functional MR by quantitative method in severe AS and to compare with conventional semiquantitative method and its relation to LV ventricular function.Methods: We studied prospectively 101 patients (39 women, age 70 ± 11 years) with severe AS (aortic valve area < 1 cm2). Functional MR was present in 67 patients (66%) by color and spectral Doppler. Effective regurgitant orifice (ERO) and regurgitant volume (RV) were estimated in 27 patients (27%) by proximal isovelocity surface area method. Ventricular function was assessed by mean of ejection fraction (EF), midwall fractional shortening (mFS) and end systolic volume (ESV), and remodeling by eccentricity index (EI) and the angle between mitral inflow (color) and mitral annulus. LVSP was estimated as: braquial systolic pressure + aortic Doppler mean gradient. Momentum of MR jet was calculated as: ERO x (Peak velocity of MR jet cw)2.Results: Using semiquantitative approach, 30 patients (45 %) had mild, 28 (42%) moderate and 9 (13%) severe MR. By quantitative method ERO was 5.3 ▪ 3.2 mm2 corresponding to mild MR in all cases. There was no correlation between ERO and JA. In univariate analysis, ERO and RV correlated inversely with EF (r = -0.40 p<0.05) and did not correlated with LVSP, mFS, ESV and EI. JA had correlation with mFS (r = -0.50 p<0.0001), ESV (r = 0.40 p<0.003), EI (r = -0.40 p<0.003), angle (r = -0.51 <0.0004), LVSP (r = -0.52 p<0.0001) and momentum (r = 0.48 p<0.0001). LVSP was related directly to EF and mFS and inversely to ESV. Using multiple linear regression analysis, EF was predictor of ERO, whereas LVSP and EI were of JA.Conclusion: In patients with AS and functional MR the relationship between LVSP and JA was inverse, which differs from other types of MR. ERO and RV correlated only with EF, whereas JA appears related to ventricular function and LV remodeling.

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