What question did this study set out to answer?

To determine whether simultaneous left atrial and systemic arterial dilution curves following left ventricular dye injection can reliably quantify mitral regurgitant and forward blood flow.

October 1, 1961CirculationOpen Access

Measurement of Mitral Regurgitation in Man from Simultaneous Atrial and Arterial Dilution Curves after Ventricular Injection

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Why the study?

Does the simultaneous atrial and arterial dilution curve method accurately and reproducibly measure mitral regurgitation in patients with rheumatic mitral valve disease?

Population

16 patients with rheumatic disease of the mitral valve

Design

Cohort

Authors

GLGilbert E. LevinsonRutgers, The State University of New Jersey SSSamuel W. SteinSan Diego Cardiac Center RCRichard A. CarletonDartmouth College

Discussion

Member takes

Implication

Poor reproducibility cautions against clinical use of dilution curves for mitral regurgitation quantification; leaves open validation of more reliable methods.

Key Points

To determine whether simultaneous left atrial and systemic arterial dilution curves following left ventricular dye injection can reliably quantify mitral regurgitant and forward blood flow.
Evaluated forward and regurgitant blood flow in 16 patients with rheumatic mitral valve disease using left ventricular injections of Evans-blue dye.
Recorded simultaneous indicator-dilution curves from the left atrium and systemic artery.
Assessed duplicate studies in 7 patients to determine the reproducibility of calculated flow volumes.
Regurgitant flow averaged 6% (range 0% to 11%) of total left ventricular output in pure mitral stenosis, 21% (8% to 39%) in predominant stenosis with mild-to-moderate insufficiency, and 58% (28% to 82%) in predominant or pure insufficiency.
Eight determinations in 6 patients yielded results that were physiologically implausible, mathematically absurd, or contradictory to clinical evidence.
Duplicate determinations (N=7) demonstrated poor reproducibility, with a mean absolute difference of 17% of total left ventricular output and a coefficient of variation of 23%.

Structured PICO

Does the simultaneous atrial and arterial dilution curve method accurately and reproducibly measure mitral regurgitation in patients with rheumatic mitral valve disease?

Population

16 patients with rheumatic disease of the mitral valve (including pure mitral stenosis, predominant stenosis with mild to moderate insufficiency, and predominant or pure insufficiency)

Intervention

Simultaneous systemic arterial and left atrial dilution curves after injection of Evans-blue dye into the left ventricle

Outcome

Measurement of forward and regurgitant flow (expressed as a per cent of estimated total left ventricular output) and reproducibility of resultssurrogate

The simultaneous atrial and arterial dilution curve method for measuring mitral regurgitation is theoretically sound but too capricious and poorly reproducible to be a dependable quantitative method.

Limitations

Unrepresentative sampling from the left atrium in the presence of incomplete mixing of indicator with blood in the cardiac chambers
Potential error from enhanced pulmonary collateral blood flow providing an alternative short pathway from the left ventricle to the left atrium

Cite This Study

Levinson et al. (1961) studied this question.

synapsesocial.com/papers/6a73ea6bc973d0bd5a69f9da https://doi.org/10.1161/01.cir.24.4.720

Topics

Mitral valve intervention Valvular heart disease

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Implication

Poor reproducibility cautions against clinical use of dilution curves for mitral regurgitation quantification; leaves open validation of more reliable methods.

Measurement of Mitral Regurgitation in Man from Simultaneous Atrial and Arterial Dilution Curves after Ventricular Injection

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

Measurement of Mitral Regurgitation in Man from Simultaneous Atrial and Arterial Dilution Curves after Ventricular Injection

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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