Résumé
Non invasive assessment of diastolic filling pressure by Doppler echocardiography is important for the interpretation of symptoms and optimization of unloading therapy in patients with severe mitral stenosis. Recently a novel Doppler time interval between the onset of early diastolic velocity mitral inflow velocity [E] and annular early diatolic velocity [Ea] by tissue Doppler imaging [T[E-Ea]], have been proposed as one of the useful indices for this assessment. Therefore, this research was intended to assess the clinical utility of this time interval [T[E-Ea], have been proposed as one of the useful indices for this assessment. Therefore, this research was intended to assess the clinical utility of this time interval [T[E-Ea] for evaluation and prediction of pulmonary capillary wedge pressure [PCWP] in patients with severe mitral stenosis. Fifty patients with severe mitral stenosis were subjected to conventional and Tissue Doppler Imaging echocardiography to estimate the time interval [T[E-Ea], and all the routine 2D, M-mode, and Doppler echocardiographic measurement were taken, simultaneously right side heart catheterization for assessment of pulmonary capillary wedge pressure was done [as can as possible] before and after balloon mitral valvuloplasty. The mean age was [26.7 +/- 5.1 years], mitral valve area range was [0.8 to 1.2Cm[2]], and before mitral valvuloplasty the estimated PCWP [by Doppler equations] was [30.8 +/- 15.3] and assessed one [by catheterization] was [30.2 +/- 14.1 for], where both values were nearly comparable. While among several Doppler measurements the strongest correlation with PCWP had been observed with Isovolumetric Relaxation Time/time constant of LV relaxation [IVRT/Tau] where [r=-0.96, p<0.001] followed by IVRT/TE-Ea [r=-0.40, p<0.001]. Also, the same previous Doppler ratios tracked well the changes in PCWP after mitral valve dilatation, and both of them were able to predict PCWP. While other Doppler parameters failed to predict it. Importantly the cutoff value to predict PCWP> 15mmHg in mitral stenosis patients, was an IVRT/T[E-Ea] <4.7 with sensitivity and specificity of 100%. Time interval [T[E-Ea] is a useful novel Doppler index for evaluation of filling pressure, since the ratios of IVRT/T[E-Ea] or IVRT to Tau were more accurate than IVRT alone when correlated to PCWP or predict it in patients with severe mitral stenosis, as well it can track changes in PCWP after mitral valvuloplasty. Clinical Implication: Such simple equation could be used for daily application and one can use the simple ratio of IVRT/T[E-Ea] to predict PCWP> 15mmHg in patients with severe mitral stenosis and that well help to decide therapeutic strategies for such patients