Abnormal Mitral Valve Motion in Patients with Elevated Left Ventricular Diastolic Pressures

Abstract

In order to see whether or not the echocardiographically recorded mitral valve could reflect alterations in left ventricular pressure, simultaneous mitral valve echograms and left ventricular pressures were obtained on patients undergoing diagnostic cardiac catheterization. Attention was given to the left ventricular initial diastolic pressure (LVIDP), left ventricular end-diastolic pressure (LVEDP), and the atrial component of the left ventricular pressure (LVa). The echocardiographic measurements included the opening velocity of the mitral valve in early diastole (D-E slope) and the interval between the A point, which is the onset of closure of the mitral valve following atrial systole, and the C point, which represents closure of the mitral valve as indicated by the meeting of the anterior and posterior mitral leaflets. In order to compensate for variations in atrioventricular conduction, the A-C interval was subtracted from the electrocardiographic P-R interval. In 19 patients, the LVIDP was less than 14 mm Hg, the LVEDP was less than 20 mm Hg, and the LVawas less than 8 mm Hg. In these patients, the D-E slope was greater than 25 cm/sec and the PR-AC interval was greater than 0.06 sec. Six patients who had an LVIDP of 14 mm Hg or greater had a D-E slope of less than 25 cm/sec. There were 14 patients with an LVEDP greater than 20 mm Hg and an LVaof 8 mm Hg or greater. All of these patients had a PR-AC interval of less than 0.06 sec. There were an additional three patients who had an LVEDP above 20 mm Hg, but whose LVawas less than 8 mm Hg. In these three patients, the PR-AC interval was greater than 0.06 sec. Thus, the shortened PR-AC interval correlated primarily with an elevated LVa. This study indicates that the echocardiographic pattern of mitral valve motion is altered in patients who have markedly elevated left ventricular diastolic pressures.