All echocardiograms were performed and interpreted by level-III-trained sonographers and echocardiologists. Echo systems used included Vivid 3 Premium and Vivid E95 (General Electric, Milwaukee, WN, USA), Agilent 5500 (Agilent, Santa Clara, CA, USA), HP 77020 (Hewlett Packard, Andover, MA, USA), and IE33 and EPIQ (Philips, Amsterdam, The Netherlands). Diagnostic measurements and conclusions made at each study were based on criteria set forth by the relevant American Society of Echocardiography guidelines [8 (link),9 (link)]. Mitral valve assessment incorporated standard multiple views. Regurgitation severity was determined based on the integration of qualitative and semiquantitative measures, whenever possible. A diagnosis of degenerative mitral valve (MV) disease required the visualization of leaflet prolapse, signified by a ≥2 mm atrial displacement of the leaflet tip from the mitral annular level at end-systole. Pulmonary veins (PVs) were assessed bilaterally. After verification of tangentiality by color Doppler, the flow at each PV was sampled by a pulsed-wave (PW) Doppler beam placed within 1 cm of the PV ostia. Normal PVFP was defined by a peak systolic (S) velocity to peak diastolic (D) velocity ratio of 1 and above (Figure 1 ); conversely, PVFP reversal was characterized by an S to D ratio of below zero. Blunted PVFP, considered a form of non-reversed PVFP, was further identified by an S to D ratio between zero and below 1. Overall flow was determined according to the lowest S to D ratio observed. Pulmonary arterial systolic pressure (PASP) assessment was based on the peak systolic pressure gradient measured across the tricuspid valve and the estimated right atrial pressure (RAP) using the diameter and respiratory collapsibility of the inferior vena cava (IVC), both during the TTE part of each study. Global right ventricular (RV) function was evaluated qualitatively. All reports were blindly scrutinized for integrity by two physicians (A.Shechter and I.Y.).
Free full text: Click here
