Turk Kardiyol Dern Ars. 2008; 36(6): 388-394

Evaluation of the severity of mitral stenosis with a new index: isovolumic myocardial acceleration

Yelda Tayyareci¹, Gülşah Tayyareci², Yılmaz Nişancı³, Berrin Umman³, Zehra Buğra^3
1Department of Cardiology, Florence Nightingale Hospital, İstanbul
²Department of Cardiology, Siyami Ersek Cardiovascular Surgery Center, İstanbul
³Department of Cardiology, İstanbul Medicine Faculty of İstanbul University, İstanbul

OBJECTIVES
Although right ventricular (RV) systolic dysfunction is an important indicator for the severity of mitral stenosis (MS), its diagnosis is difficult before systemic signs of venous congestion occur. We assessed the association between tissue Doppler (TDI)-derived isovolumic myocardial acceleration (IVA) and the severity of MS.

STUDY DESIGN
The study included 112 MS patients (79 mild to moderate, 33 severe MS). Two-dimensional and Doppler echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional shortening, pulmonary flow acceleration time, tricuspid valve annular systolic excursion) were calculated. Additionally, TDI-derived systolic velocities of the tricuspid annulus (IVA, peak myocardial velocity during isovolumic contraction-IVV, peak systolic velocity during ejection period-Sa) were recorded. The results were compared with those of 60 age- and sex-matched healthy controls.

RESULTS
All TDI-derived systolic velocities (IVV, Sa and IVA) were significantly decreased in patients with MS (p<0.0001). However, IVA was the only parameter to distinguish the severity of MS (p<0.0001). It also showed significant correlations with the following parameters with which IVV and Sa were not correlated: mitral valve area (r=0.79, p<0.0001), mean (r=-0.54, p<0.0001) and maximum (r=-0.58, p<0.0001) transmitral diastolic gradients, pulmonary artery pressure (r=-0.54, p<0.0001), and left atrial diameter (r=-0.68, p<0.0001). The ROC curve analysis showed that an IVA of <2.9 m/sec2 predicted MS patients with 86% sensitivity, 87% specificity, and an IVA of <2 m/sec2 predicted severe MS with 82% sensitivity and 77% specificity.

CONCLUSION
Tissue Doppler-derived right ventricular IVA may be used as an adjunctive, alternative noninvasive parameter to determine the severity of MS in patients without signs of systemic venous congestion.

Keywords: Blood flow velocity, echocardiography, Doppler; heart ventricles; mitral valve stenosis; myocardial contraction; rheumatic heart disease; ventricular function, right.

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