Key result
Colour M-mode PISA accurately measured mitral valve area in early diastole (1.27 cm2) compared to 2D planimetry (1.29 cm2, p=0.59), revealing that MVA remains unchanged throughout diastole.
Why the study?
Does the colour M-mode PISA method accurately measure mitral valve area and assess flow-dependent changes during diastole in patients with mitral stenosis?
Observational (n=50)
Does the colour M-mode PISA method accurately measure mitral valve area and assess flow-dependent changes during diastole in patients with mitral stenosis?
Effect estimate: r=0.85
Absolute Event Rate: 1.27% vs 1.29%
p-value: p=0.59
Colour M-mode PISA provides accurate mitral valve area measurements in mitral stenosis and demonstrates that MVA remains unchanged throughout diastole, indicating a lack of flow-related valvular reserve.
May facilitate mitral valve area assessment in mitral stenosis; hypothesis-generating for constant MVA and lack of valvular reserve.
AIMS: In mitral stenosis (MS) transvalvular flow and velocity continually change throughout diastole but for mitral valve area (MVA), flow-dependent variations (valve reserve) are unknown. These physiologic changes can be studied by the proximal isovelocity surface area (PISA) method, using the high temporal resolution of colour M-mode, essential for simultaneous measurements of flow and velocity. Hence, we aimed to validate the colour M-mode PISA method for measurement of MVA in MS and to define using this method the physiologic flow-dependent changes of MVA during diastole. METHODS AND RESULTS: In 50 patients with native MS, MVA was measured by planimetry (MVA-2D), Doppler pressure half-time (MVA-PHT), and two-dimensional PISA (2D-PISA). MVA measurement by colour M-mode PISA in early diastole (M-PISA) (1.27+/-0.46 cm(2)) with rigorously timed flow and velocity measurements by continuous wave Doppler did not differ and correlated well with MVA-2D (1.29+/-0.44 cm(2), p=0.59; r=0.85, p<0.001) and MVA-PHT (1.30+/-0.41 cm(2), p=0.52; r=0.80, p<0.001). In contrast a trend towards underestimation of MVA by 2D-PISA was observed (1.23+/-0.42 cm(2); p=0.10 and p=0.07). Timed analysis of transvalvular haemodynamics at early, mid, mid-late, and late diastole showed marked changes in flow and velocities (both p<0.0001) but not in MVA (respectively 1.27+/-0.46, 1.29+/-0.47, 1.28+/-0.51 and 1.27+/-0.49 cm(2); ns). CONCLUSIONS: In MS, the high temporal resolution of colour M-mode PISA allows accurate MVA measurements. It also allows for the first time, sequential MVA assessment during diastole. Notwithstanding marked flow and velocities changes, MVA remained unchanged throughout diastole underscoring the lack of flow-related valvular reserve in MS.
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David Messika‐Zeitoun (2003) conducted an observational in Native mitral stenosis (n=50). Colour M-mode PISA vs. Planimetry (MVA-2D) and Doppler pressure half-time (MVA-PHT) was evaluated on Mitral valve area (MVA) measurement in early diastole (r=0.85, p=0.59). Colour M-mode PISA accurately measured mitral valve area in early diastole (1.27 cm2) compared to 2D planimetry (1.29 cm2, p=0.59), revealing that MVA remains unchanged throughout diastole.
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