Systolic Mitral Annular Velocity as a Simple Marker of Left Ventricular Peak Systolic dP/dt in Patients with Significant Mitral Regurgitation

ABSTRACT

BACKGROUND: Evaluating left ventricular (LV) contractile function in patients with mitral regurgitation (MR) is a difficult clinical problem. Although LV dP/dt measured by Doppler echocardiography has been shown to be a good marker for LV contractility, it is limited clinically due to the complexity of the measurement and the difficulty in obtaining appropriate Doppler tracings in patients with eccentric MR. We hypothesized that systolic mitral annulus velocity (S') can be a good marker of LV dP/dt. METHODS: We studied 62 patients (25 men, age 47+/-15 years) who had 3+ or 4+ MR with normal LV systolic function (ejection fraction >50%). Two-dimensional and Doppler echocardiography was performed. LV dP/dt-Doppler was measured using MR jet tracing as previously reported. S' velocity was measured at the septal annulus using Doppler tissue imaging. In 10 patients undergoing mitral surgery, LV pressure was measured with micromanometer-tipped catheter and peak dP/dt-cath was calculated. RESULTS: Mean LV ejection fraction was 60+/-6% and regurgitant fraction was 59+/-15%. S' velocity correlated well with LV dP/dt-Doppler (r=0.50, p<0.01). In 10 patients who underwent LV catheterization, LV dP/dt-Doppler correlated well with peak dP/dt-cath (r=0.68, p=0.03). Whereas S' velocity could be measured in all patients, LV dP/dt-Doppler could not be measured in 31 patients (50%) due to eccentric jet direction. CONCLUSION: Systolic mitral annulus velocity is a simple and feasible marker of LV dP/dt and, therefore, may be useful for assessing myocardial contractile function in patients with MR.