Impact of Atrioventricular Compliance on Pulmonary Artery Pressure in Mitral Stenosis
| Autor: | Zvi Vered, Ehud Schwammenthal, Micha S. Feinberg, Oren Agranat, Babeth Rabinowitz, Elieser Kaplinsky |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart Ventricles Hypertension Pulmonary Hemodynamics Heart Rate Physiology (medical) Mitral valve Internal medicine medicine.artery medicine Humans Mitral Valve Stenosis Heart Atria Pulmonary Wedge Pressure Atrium (heart) Pressure gradient Aged business.industry Middle Aged medicine.disease Myocardial Contraction Echocardiography Doppler Compliance (physiology) Stenosis medicine.anatomical_structure Blood pressure Pulmonary artery Exercise Test Cardiology Female Cardiology and Cardiovascular Medicine business Compliance |
| Zdroj: | Circulation. 102:2378-2384 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.102.19.2378 |
| Popis: | Background —The decay of the pressure gradient across a stenotic mitral valve is determined by the size of the orifice and net AV compliance (C n ). We have observed a group of symptomatic patients, usually in sinus rhythm, characterized by pulmonary hypertension (particularly during exercise) despite a relatively large mitral valve area by pressure half-time. We speculated that this discrepancy was due to low atrial compliance causing both pulmonary hypertension and a steep decay of the transmitral pressure gradient despite significant stenosis. We therefore tested the hypothesis that C n is an important physiological determinant of pulmonary artery pressure at rest and during exercise in mitral stenosis. Methods and Results —Twenty patients with mitral stenosis were examined by Doppler echocardiography. C n , calculated from the ratio of effective mitral valve area (continuity equation) and the E-wave downslope, ranged from 1.7 to 8.1 mL/mm Hg. Systolic pulmonary artery pressure (PAP) increased from 43±12 mm Hg at rest to 71±23 mm Hg (range, 40 to 110 mm Hg) during exercise. There was a particularly close correlation between C n and exercise PAP ( r =−0.85). Patients with a low compliance were more symptomatic ( P n , determined in 10 cases, correlated well ( r =0.79). Conclusions —C n , which can be noninvasively assessed, is an important physiological determinant of PAP in mitral stenosis. Patients with low C n represent an important clinical entity, with symptoms corresponding to severe increases in PAP during stress echocardiography. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|