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Hauge SW, Estensen ME, Persson R, Abebe S, Mekonnen D, Nega B, Solholm A, Graven T, Salvesen O, Farstad M, Vikenes K, Haaverstad R, Dalen H. The importance of concomitant mitral regurgitation for estimates of mitral valve area by pressure half time in patients with chronic rheumatic heart disease. Int J Cardiol 2024; 398:131600. [PMID: 37996013 DOI: 10.1016/j.ijcard.2023.131600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/25/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
AIMS Aim was to study how concomitant mitral regurgitation (MR) assessed by qualitative and quantitative methods influence mitral valve area (MVA) calculations by the pressure half time method (MVAPHT) compared to reference MVA (planimetry) in patients with rheumatic heart disease. METHODS AND RESULTS In 72 patients with chronic rheumatic heart disease, MVAPHT was calculated as 220 divided by the pressure half time of the mitral early inflow Doppler spectrum. Direct measurement by planimetry was used as reference MVA and was mean (SD) 0.99 (0.69-1.99) cm2. Concomitant MR was present in 82%. MR severity was assessed qualitatively in all, semi-quantitatively by measuring the vena contracta width in 58 (81%), and quantitatively by calculation of the regurgitant volume in 28 (39%). MVA was significantly underestimated by MVAPHT, with increasing MR. In regression analyses MVAPHT underestimated MVA by 0.19 cm2 per higher grade of MR severity in qualitative assessment, and by 0.12-0.13 cm2 per mm larger vena contracta width and 10 ml larger regurgitant volume, respectively. The presented associations were more evident when i) MR severity was quantified compared to qualitative assessment and ii) reference measurements were made by three-dimensional transoesophageal recordings compared to transthoracic recordings. CONCLUSION MVAPHT underestimated mitral valve area compared to planimetry in patients with MS and concomitant MR. This study highlights the importance of taking the MR severity into account when evaluating MVA based on the PHT method. Direct measurements should be included in clinical decision making.
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Affiliation(s)
- Stale W Hauge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.
| | - Mette E Estensen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Robert Persson
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sintayehu Abebe
- Department of Cardiology, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Desalew Mekonnen
- Department of Cardiology, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Berhanu Nega
- Department of Surgery, School of Medicine, CHS, Addis Ababa University, Addis Ababa, Ethiopia
| | - Atle Solholm
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Oivind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Farstad
- Department of Surgical Services, Haukeland University Hospital, Bergen, Norway
| | - Kjell Vikenes
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Rune Haaverstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Levanger, Norway
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