Usefulness of Mitral Valve Prosthetic or Bioprosthetic Time Velocity Index Ratio to Detect Prosthetic or Bioprosthetic Mitral Valve Dysfunction.

Autor: Luis SA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia. Electronic address: Luis.S@mayo.edu., Blauwet LA; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota., Samardhi H; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia., West C; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia., Mehta RA; Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota., Luis CR; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia., Scalia GM; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia., Miller FA Jr; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota., Burstow DJ; School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2017 Oct 15; Vol. 120 (8), pp. 1373-1380. Date of Electronic Publication: 2017 Jul 25.
DOI: 10.1016/j.amjcard.2017.07.026
Abstrakt: This study aimed to investigate the utility of transthoracic echocardiographic (TTE) Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define optimal cut-off values for identification of such dysfunction by valve type. In total, 971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with transesophageal echocardiography for evaluation of mitral prosthesis function. Among all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47, p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination of clinically normal and clinically abnormal prostheses. Optimal cut-off values by receiver operating characteristic analysis for differentiating clinically normal and abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity improved specificity (92%) and positive predictive value (65%) compared with either parameter alone, with minimal decline in negative predictive value (92%). Pressure halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically normal and clinically abnormal prostheses but was useful in discriminating obstructed from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived Doppler parameters of MVP function were specific to prosthesis type and carried high sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio was the best predictor of prosthetic dysfunction and, combined with E velocity, provided a useful parameter for determining likelihood of dysfunction and need for further assessment.
(Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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