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Published on: September 16, 2009
The echocardiographic determination of mitral valve opening and closure. Correlation with hemodynamic studies in man
Insights
Echocardiography reliably indicates mitral valve opening and closure, correlating closely with hemodynamic measurements. This noninvasive technique accurately determines key systolic and diastolic time intervals in patients.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Accurate assessment of mitral valve function is crucial for diagnosing and managing cardiac conditions.
- Echocardiography is a widely used noninvasive imaging technique for evaluating cardiac structures and function.
- Simultaneous recording of echocardiographic and hemodynamic data allows for precise correlation of valve events.
Purpose of the Study:
- To assess the reliability of anterior leaflet echocardiography in defining mitral valve opening and closure.
- To compare echocardiographic markers of mitral valve events with simultaneous intracardiac pressure measurements.
- To evaluate the noninvasive determination of systolic and diastolic time intervals using echocardiography.
Main Methods:
- Simultaneous recording of anterior leaflet echocardiography (ECHO) with intracardiac pressures, aortic second sound, and ECG.
- 38 recordings in 14 patients undergoing cardiac catheterization.
- Defined hemodynamic opening/closure by pressure intersections and onset of systole; echocardiographic markers were D' (opening) and Co (closure).
Main Results:
- Significant regression equations showed high correlation between echocardiographic and hemodynamic measurements for isovolumic relaxation period (IRPE = 0.97*IRPH + 30, r=0.89), Q to closure interval (QCIE = 0.68*QCIH + 37, r=0.71), and diastolic filling period (DFPE = 0.98*DFPH + 10, r=0.98).
- Hemodynamic markers systematically preceded echocardiographic markers.
- Diastolic filling periods were virtually identical (within 10 msec).
Conclusions:
- Anterior leaflet echocardiography is a reliable indicator of hemodynamic mitral valve opening and closure in humans.
- Echocardiography provides a useful noninvasive method for determining critical systolic and diastolic time intervals.
- This validates echocardiography as a dependable tool for assessing mitral valve dynamics and timing.
Abstract:
The ability of the echocardiogram to define mitral valve opening and closure was assessed by simultaneously recording the echocardiogram of the anterior leaflet (ECHO) with intracardiac pressures, aortic second sound, and ECG on 38 occasions in 14 patients undergoing cardiac catheterization. Hemodynamic opening and closure were defined by intersection of the pulmonary wedge and left ventricular pressures and the onset of left ventricular systole. The onset of the most rapid anterior motion (D') in early diastole and termination of the last rapid posterior movement in end diastole (Co) were used as echocardiographic markers of mitral valve opening and closure. Intervals measured included: the isovolumic relaxation period (IRP) from A2 to either hemodynamic (IRPH) or echocardiographic (IRPE) opening; the Q to closure interval (QCI) from the Q wave to either hemodynamic (QCIH) or echocardiographic (QCIE) closure; and diastolic filling period (DFP), either hemodynamic (DFPH) or echocardiographic (DFPE). The following significant (P less than .01) regression equations resulted: IRPE equals (.97) IRPH plus 30 (sem plus or minus 8 msec) r equals .89; QCIE equals (.68) QCIH plus 37 (sem plus or minus 7 msec) r equals .71; DEPE equals (.98) DFPH plus 10 (sem plus or minus 18 msec) r equals .98. Thus hemodynamic markers of opening and closure systematically precede echocardiographic markers of opening (D') and closure (Co) and the diastolic filling periods are equal within 10 msec. It is concluded that the echocardiogram of the anterior leaflet is a reliable indicator of hemodynamic markers of opening and closure of the mitral valve in man and is useful in the noninvasive determination of certain systolic and diastolic time intervals.
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