Doppler-Derived Left Ventricular Negative dP/dt as a Predictor of Atrial Fibrillation or Ischemic Stroke in Patients with Degenerative Mitral Regurgitation and Normal Ejection Fraction

作者：Yi Jeong Eun; Lee Dong Hyeon; Cho Eun Joo; Jeon Hui Kyung; Jung Hae Ok; Youn Ho Joong^*

来源：Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques, 2014, 31(3): 285-292.

DOI：10.1111/echo.12350

• Doppler-derived LV -dP
• dt
• degenerative mitral regurgitation
• atrial fibrillation
• ischemic stroke

IntroductionThe aim of this study was to investigate the role of Doppler-derived left ventricular (LV) -dP/dt in predicting atrial fibrillation (AF) or ischemic stroke in patients with moderate to severe degenerative mitral regurgitation (MR). %26lt;br%26gt;MethodsDoppler-derived LV -dP/dt was determined from the continuous-wave Doppler spectrum of the MR jet (-dP/dt=32/time between 3 and 1m/sec) in 80 patients (mean age 5916years, 41% men) with moderate to severe degenerative MR, normal LV ejection fraction (LVEF60%), and sinus rhythm at diagnosis. Events were defined as new AF or ischemic stroke. %26lt;br%26gt;ResultsDuring a mean follow-up of 18 +/- 13months, there were 9 events (6 new AF, 3 ischemic strokes). Univariate analysis showed that older age, decreased LV -dP/dt, increased LV mass index, and left atrial volume index (LAVI), shortened deceleration time (DT), reduced A velocity, and elevated E/E ratio, prolongation of pulmonary venous (PV) atrial reversal (AR) flow duration relative to mitral inflow A-wave duration (AR-Adur) were associated with events. In multivariate Cox regression analysis, Doppler-derived LV -dP/dt (for each 100mmHg/sec increase, hazard ratio: 0.165, 95% confidence interval: 0.036-0.761, P=0.021) and E/E (hazard ratio: 0.820, 95% confidence interval: 0.682-0.987, P=0.036) were significant independent predictors of AF or ischemic stroke. %26lt;br%26gt;ConclusionsDoppler-derived LV -dP/dt is independently associated with the occurrence of AF or ischemic stroke in patients with moderate to severe degenerative MR and provides additional prognostic information.

• 出版日期2014-3