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Murayama M, Iwano H, Tsujinaga S, Nishino H, Yokoyama S, Nakabachi M, Sarashina M, Ishizaka S, Chiba Y, Okada K, Kaga S, Nishida M, Kamiya K, Nagai T, Anzai T. Simple echocardiographic scoring system to estimate left ventricular filling pressure based on visual assessment of time sequence of mitral and tricuspid valve opening. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
In the presence of elevated left ventricular (LV) filling pressure, mitral valve (MV) becomes to open early and precedes tricuspid valve (TV) opening in early diastole. Accordingly, time-delay of right ventricular inflow relative to LV inflow assessed by dual Doppler system was recently reported as a parameter of LV filling pressure. We assumed that visually-assessed time-delay of TV relative to MV opening could be a simple and alternative marker of elevated LV filling pressure.
Purpose
This study aimed to elucidate the clinical usefulness of the 2-dimensional echocardiographic scoring system, Visual assessment of time-difference between Mitral and Tricuspid valve opening (VMT) score, in patients with heart failure (HF).
Methods
We analyzed 119 consecutive HF patients who underwent echocardiography and cardiac catheterization within a day. Elevated LV filling pressure was defined as mean pulmonary arterial wedge pressure (PAWP) ≥15 mmHg. LV diastolic function was graded according to the ASE/EACVI recommendations. Time sequence of opening of MV and TV was visually assessed in the apical 4-chamber view and scored to 3 grades (0: TV opening first, 1: simultaneous, 2: MV opening first). When the inferior vena cava diameter was >21 mm and collapsed <20% during normal respiration, 1 point was added and VMT score was calculated as 4 grades from 0 to 3. We also investigated 113 patients without worsening HF at VMT scoring for cardiac events defined as worsening HF, LV assist device implantation, or cardiac death for 1 year after the echocardiography.
Results
VMT was scored as 0 in 20 patients, 1 in 50 patients, 2 in 37 patients, and 3 in 12 patients. PAWP was elevated in patients with VMT score of 2 and 3 (0: 10±5, 1: 12±4, 2: 22±8, 3: 28±4 mmHg, ANOVA P<0.001) (Figure). In overall patients, VMT≥2 predicted elevated PAWP with accuracy of 86%. When the accuracy was tested in patients with reduced (<40%, HFrEF) and preserved LV ejection fraction (≥40%) respectively, the accuracy was excellent in HFrEF (96% and 77%, respectively). Importantly, VMT≥2 also had good accuracy of 82% for elevated PAWP in 33 patients in whom recommendations usually cannot grade diastolic function due to monophasic LV inflow. In the sequential Cox models, the addition of VMT score to the model including the plasma brain natriuretic peptide (BNP) level and LV diastolic grading improved the predictive power for elevated PAWP (P<0.001). During the follow-up, 20 cardiac events were observed (6 worsening HF, 9 LV assist device implantation and 5 cardiac death). Kaplan-Meier analysis showed that the patients with VMT≥2 were at higher risk of cardiac events than those with VMT≤1 (log-rank test P<0.001) (Figure).
Conclusions
The VMT score was a simple and accurate marker of elevated LV filling pressure and has an incremental benefit over BNP and LV diastolic function grading. Moreover, it could be a novel prognostic marker in patients with HF.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Murayama
- Hokkaido University Hospital, Sapporo, Japan
| | - H Iwano
- Hokkaido University Hospital, Sapporo, Japan
| | - S Tsujinaga
- Hokkaido University Hospital, Sapporo, Japan
| | - H Nishino
- Hokkaido University Hospital, Sapporo, Japan
| | - S Yokoyama
- Hokkaido University Hospital, Sapporo, Japan
| | - M Nakabachi
- Hokkaido University Hospital, Sapporo, Japan
| | - M Sarashina
- Hokkaido University Hospital, Sapporo, Japan
| | - S Ishizaka
- Hokkaido University Hospital, Sapporo, Japan
| | - Y Chiba
- Hokkaido University Hospital, Sapporo, Japan
| | - K Okada
- Hokkaido University, Sapporo, Japan
| | - S Kaga
- Hokkaido University, Sapporo, Japan
| | - M Nishida
- Hokkaido University Hospital, Sapporo, Japan
| | - K Kamiya
- Hokkaido University Hospital, Sapporo, Japan
| | - T Nagai
- Hokkaido University Hospital, Sapporo, Japan
| | - T Anzai
- Hokkaido University Hospital, Sapporo, Japan
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Noda M, Yamaguchi H, Fujii H, Kakuta T, Sarashina M, Sakurada H, Kishi Y, Isobe M, Numano F. Spontaneous regression over a 16-year period of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block in a young patient with Ebstein's anomaly. Pacing Clin Electrophysiol 2001; 24:1158-60. [PMID: 11475834 DOI: 10.1046/j.1460-9592.2001.01158.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 25-year-old man with Ebstein's anomaly showed spontaneous regression of tachyarrhythmias to sick sinus syndrome and complete atrioventricular block over a 16-year period. This is the first clinical report supporting the hypothesis that abnormal cell death might contribute to the disturbance of the heart conduction system in Ebstein's anomaly.
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Affiliation(s)
- M Noda
- Third Department of Internal Medicine, Tokyo Medical and Dental University, Tokyo.
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