Impact of Cardiac Rhythm on Mitral Valve Area Calculated by the Pressure Half Time Method in Patients With Moderate or Severe Mitral Stenosis

Hyung Kwan Kim; Yong Jin Kim; Sung A. Chang; Dae Hee Kim; Dae Won Sohn; Byung Hee Oh; Young Bae Park

doi:10.1016/j.echo.2008.11.007

Impact of Cardiac Rhythm on Mitral Valve Area Calculated by the Pressure Half Time Method in Patients With Moderate or Severe Mitral Stenosis

Hyung Kwan Kim, Yong Jin Kim, Sung A. Chang, Dae Hee Kim, Dae Won Sohn, Byung Hee Oh, Young Bae Park

Seoul National University

Research output: Contribution to journal › Article › peer-review

21 Scopus citations

Abstract

Background: The pressure half-time (PHT) method has been widely used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS), in the belief that this simple method provides reliable information on true MVA. However, its limitation has been repeatedly recognized under different circumstances. The aim of this study was to evaluate the effect of cardiac rhythm on PHT-derived MVA calculation in relation to net atrioventricular compliance (C_n). Methods: Patients (n = 41) with rheumatic pure moderate or severe MS were consecutively recruited. Eighteen patients with sinus rhythm were allocated to group 1 and the remaining patients with chronic atrial fibrillation to group 2. MVA was obtained using the PHT method and by planimetry (considered the gold standard in this study). C_n was calculated with a previously validated equation. Results: There were no differences between the 2 groups in terms of age, gender, left ventricular dimensions or ejection fraction, or transmitral pressure gradient. Left atrial volume index (134.6 ± 106.7 vs 79.2 ± 16.8 mL; P = .003) and C_n (6.6 ± 1.5 vs 4.7 ± 1.2 mL/mm Hg; P < .001) were higher in group 2 than in group 1. Disagreement of MVA estimation by PHT compared with that by 2-dimensional planimetry was 8.0 ± 19.2% for group 1 and -24.9 ± 13.9% for group 2 (P = .002). In addition, the extent of disagreement of PHT-derived MVA compared with that by 2-dimensional planimetry was significantly correlated with C_n (r² = 0.71, P < .001). MVA by the PHT method was estimated to be substantially higher in patients with C_n values < 4 mL/mm Hg, most of whom were in sinus rhythm. Multivariate analysis confirmed the independent association of cardiac rhythm with discrepancy of PHT-derived MVA compared with that by planimetry. Conclusion: Changes in cardiac rhythm with associated modifications of C_n can alter the accuracy of the PHT method for estimating MVA. Given the limitation described here, 2-dimensional planimetry, not the PHT method, should be used as a primary echocardiographic tool for MVA calculation.

Original language	English
Pages (from-to)	42-47
Number of pages	6
Journal	Journal of the American Society of Echocardiography
Volume	22
Issue number	1
DOIs	https://doi.org/10.1016/j.echo.2008.11.007
State	Published - Jan 2009
Externally published	Yes

Keywords

Compliance
Echocardiography
Mitral valve
Pressure half-time
Stenosis

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10.1016/j.echo.2008.11.007

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@article{3a28668f3117444ba86d0717af37ebfb,

title = "Impact of Cardiac Rhythm on Mitral Valve Area Calculated by the Pressure Half Time Method in Patients With Moderate or Severe Mitral Stenosis",

abstract = "Background: The pressure half-time (PHT) method has been widely used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS), in the belief that this simple method provides reliable information on true MVA. However, its limitation has been repeatedly recognized under different circumstances. The aim of this study was to evaluate the effect of cardiac rhythm on PHT-derived MVA calculation in relation to net atrioventricular compliance (Cn). Methods: Patients (n = 41) with rheumatic pure moderate or severe MS were consecutively recruited. Eighteen patients with sinus rhythm were allocated to group 1 and the remaining patients with chronic atrial fibrillation to group 2. MVA was obtained using the PHT method and by planimetry (considered the gold standard in this study). Cn was calculated with a previously validated equation. Results: There were no differences between the 2 groups in terms of age, gender, left ventricular dimensions or ejection fraction, or transmitral pressure gradient. Left atrial volume index (134.6 ± 106.7 vs 79.2 ± 16.8 mL; P = .003) and Cn (6.6 ± 1.5 vs 4.7 ± 1.2 mL/mm Hg; P < .001) were higher in group 2 than in group 1. Disagreement of MVA estimation by PHT compared with that by 2-dimensional planimetry was 8.0 ± 19.2\% for group 1 and -24.9 ± 13.9\% for group 2 (P = .002). In addition, the extent of disagreement of PHT-derived MVA compared with that by 2-dimensional planimetry was significantly correlated with Cn (r2 = 0.71, P < .001). MVA by the PHT method was estimated to be substantially higher in patients with Cn values < 4 mL/mm Hg, most of whom were in sinus rhythm. Multivariate analysis confirmed the independent association of cardiac rhythm with discrepancy of PHT-derived MVA compared with that by planimetry. Conclusion: Changes in cardiac rhythm with associated modifications of Cn can alter the accuracy of the PHT method for estimating MVA. Given the limitation described here, 2-dimensional planimetry, not the PHT method, should be used as a primary echocardiographic tool for MVA calculation.",

keywords = "Compliance, Echocardiography, Mitral valve, Pressure half-time, Stenosis",

author = "Kim, \{Hyung Kwan\} and Kim, \{Yong Jin\} and Chang, \{Sung A.\} and Kim, \{Dae Hee\} and Sohn, \{Dae Won\} and Oh, \{Byung Hee\} and Park, \{Young Bae\}",

year = "2009",

month = jan,

doi = "10.1016/j.echo.2008.11.007",

language = "English",

volume = "22",

pages = "42--47",

journal = "Journal of the American Society of Echocardiography",

issn = "0894-7317",

publisher = "Elsevier Inc.",

number = "1",

}

TY - JOUR

T1 - Impact of Cardiac Rhythm on Mitral Valve Area Calculated by the Pressure Half Time Method in Patients With Moderate or Severe Mitral Stenosis

AU - Kim, Hyung Kwan

AU - Kim, Yong Jin

AU - Chang, Sung A.

AU - Kim, Dae Hee

AU - Sohn, Dae Won

AU - Oh, Byung Hee

AU - Park, Young Bae

PY - 2009/1

Y1 - 2009/1

N2 - Background: The pressure half-time (PHT) method has been widely used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS), in the belief that this simple method provides reliable information on true MVA. However, its limitation has been repeatedly recognized under different circumstances. The aim of this study was to evaluate the effect of cardiac rhythm on PHT-derived MVA calculation in relation to net atrioventricular compliance (Cn). Methods: Patients (n = 41) with rheumatic pure moderate or severe MS were consecutively recruited. Eighteen patients with sinus rhythm were allocated to group 1 and the remaining patients with chronic atrial fibrillation to group 2. MVA was obtained using the PHT method and by planimetry (considered the gold standard in this study). Cn was calculated with a previously validated equation. Results: There were no differences between the 2 groups in terms of age, gender, left ventricular dimensions or ejection fraction, or transmitral pressure gradient. Left atrial volume index (134.6 ± 106.7 vs 79.2 ± 16.8 mL; P = .003) and Cn (6.6 ± 1.5 vs 4.7 ± 1.2 mL/mm Hg; P < .001) were higher in group 2 than in group 1. Disagreement of MVA estimation by PHT compared with that by 2-dimensional planimetry was 8.0 ± 19.2% for group 1 and -24.9 ± 13.9% for group 2 (P = .002). In addition, the extent of disagreement of PHT-derived MVA compared with that by 2-dimensional planimetry was significantly correlated with Cn (r2 = 0.71, P < .001). MVA by the PHT method was estimated to be substantially higher in patients with Cn values < 4 mL/mm Hg, most of whom were in sinus rhythm. Multivariate analysis confirmed the independent association of cardiac rhythm with discrepancy of PHT-derived MVA compared with that by planimetry. Conclusion: Changes in cardiac rhythm with associated modifications of Cn can alter the accuracy of the PHT method for estimating MVA. Given the limitation described here, 2-dimensional planimetry, not the PHT method, should be used as a primary echocardiographic tool for MVA calculation.

AB - Background: The pressure half-time (PHT) method has been widely used to estimate mitral valve area (MVA) in patients with mitral stenosis (MS), in the belief that this simple method provides reliable information on true MVA. However, its limitation has been repeatedly recognized under different circumstances. The aim of this study was to evaluate the effect of cardiac rhythm on PHT-derived MVA calculation in relation to net atrioventricular compliance (Cn). Methods: Patients (n = 41) with rheumatic pure moderate or severe MS were consecutively recruited. Eighteen patients with sinus rhythm were allocated to group 1 and the remaining patients with chronic atrial fibrillation to group 2. MVA was obtained using the PHT method and by planimetry (considered the gold standard in this study). Cn was calculated with a previously validated equation. Results: There were no differences between the 2 groups in terms of age, gender, left ventricular dimensions or ejection fraction, or transmitral pressure gradient. Left atrial volume index (134.6 ± 106.7 vs 79.2 ± 16.8 mL; P = .003) and Cn (6.6 ± 1.5 vs 4.7 ± 1.2 mL/mm Hg; P < .001) were higher in group 2 than in group 1. Disagreement of MVA estimation by PHT compared with that by 2-dimensional planimetry was 8.0 ± 19.2% for group 1 and -24.9 ± 13.9% for group 2 (P = .002). In addition, the extent of disagreement of PHT-derived MVA compared with that by 2-dimensional planimetry was significantly correlated with Cn (r2 = 0.71, P < .001). MVA by the PHT method was estimated to be substantially higher in patients with Cn values < 4 mL/mm Hg, most of whom were in sinus rhythm. Multivariate analysis confirmed the independent association of cardiac rhythm with discrepancy of PHT-derived MVA compared with that by planimetry. Conclusion: Changes in cardiac rhythm with associated modifications of Cn can alter the accuracy of the PHT method for estimating MVA. Given the limitation described here, 2-dimensional planimetry, not the PHT method, should be used as a primary echocardiographic tool for MVA calculation.

KW - Compliance

KW - Echocardiography

KW - Mitral valve

KW - Pressure half-time

KW - Stenosis

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DO - 10.1016/j.echo.2008.11.007

M3 - Article

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AN - SCOPUS:58149087740

SN - 0894-7317

VL - 22

SP - 42

EP - 47

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

IS - 1

ER -

Impact of Cardiac Rhythm on Mitral Valve Area Calculated by the Pressure Half Time Method in Patients With Moderate or Severe Mitral Stenosis

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Keywords

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