| Abstract: | Summary. Objectives: to study the relationship between pulmonary venous systolic flow fraction (PVSFfr) recorded using pulsed Doppler transesophageal echocardiography and angiographic grading and haemodynamic parameters in subgroups of patients with mitral regurgitation. Background: reversed systolic pulmonary venous flow is a sensitive sign of severe mitral regurgitation. Scarse data are available regarding the effects of atrial fibrillation and coronary artery disease. Methods: PVSFfr was calculated as the systolic flow velocity integral divided by the total inflow integral. PVSFfr is negative when systolic flow is dominantly reversed. 111 patients were studied. Results: PVSFfr<0 was 91% sensitive for angiographic severe mitral regurgitation (MR) (specificity 75%). In patients with sinus rhytm and without coronary artery disease the sensivity was 100% and specificity was 86% (n= 25). PVSFfr correlated to angiographic grade (r= -0.63, P= 0.0001), mean PCW (r= -0.63, P= 0.0001), v-wave (r=-0.72, P= 0.0001), systolic blood pressure (r= 0.28, P= 0.003) and left atrial diameter (r= -0.42, P= 0.0001) (n= 111). Stepwise linear regression analysis revealed the v-wave, angiographic grading, left atrial diameter and systolic blood pressure to be independent predictors of PVSFfr. Subgroup analysis revealed a correlation (r= 0.85, n= 25) between angiographic grading and PVSFfr in patients with sinus rhythm without CAD and (r= 0.35, n= 23) in patients with CAD in atrial fibrillation. Conclusions: PVSFfr is valuable in assessing mitral regurgitation. In the presence of atrial fibrillation and coronary artery disease the correlation with angiographic grading decreases indicating the dynamic nature of this valvular lesion. |
