Accuracy of The Single Beat Method for Assessment of Mitral Valve
Stenosis Severity in Atrial Fibrillation
Abstract
Purpose: In mitral stenosis (MS) patients, determining stenosis
severity in atrial fibrillation (AF) is time-consuming by averaging
measurement by multiple cardiac cycles. Whether a single beat method can
be used to measure the mitral valve area (MVA) and transmitral gradient
for stenosis severity assessment in AF is still uncertain.
Methods: Forty-eight MS patients with AF (mean age 46.8+8.6
years) underwent routine echocardiographic study. The MVA by pressure
half time (PHT) and transmitral mean gradient were measured by four
methods: the standard approach (averaging multiple beats), single short
R-R cycle, single long R-R cycle, and single beat RRp/RRpp = 1. 2D and
3D planimetry MVA were measured at the mitral orifice. Results:
The single beat RRp/RRpp = 1 showed no significant difference in MVA PHT
measurement compared with standard approach (0.8 (0.3 – 2.7 vs 0.9 +
0.3 cm 2 ) cm 2, P = 0.472),
whereas there was a significant difference in MVA by PHT when short R-R
cycle (1.0 (0.4 – 2.7) cm 2, P = 0.0001) and
long R-R cycle (0.8 (0.3 – 1.7) cm 2, P =
0.013) were selected. There was a significant difference in mean MVG
measurement when short R-R cycle (12.1 + 3.9 mmHg, P = 0.001) ,
long R-R cycle (10.1 + 4.0 mmHg, P = 0.007), and single beat
RRp/RRpp = 1 (12.2 + 4.4 mmHg, P = 0.0001) were selected.
Correlation coefficients for MVA PHT calculated by single beat RRp/RRpp
= 1 compared with MVA PHT measured by standard approach are r =
0.87 ( P < 0.001). There is weak correlation in
measurement MVA between PHT single beat RRp/RRpp = 1 and 3D planimetry (
r = 0.316, P = 0.044). Conclusion: In AF, the
single beat method RRp/RRpp = 1 for measurement MVA by PHT in MS has a
high correlation with the current standard approach by averaging
multiple beats. Compared with MVA by 3D planimetry as the reference
measurement of MVA, measurement of MVA by PHT standard approach and
single beat RRp/RRpp = 1 have a weak correlation in AF patients. MVA by
planimetry especially 3D planimetry, is considered as a reference
measurement, but MVA by PHT single beat RRp/RRpp =1 can be an
alternative, especially when MVA by planimetry is not feasible.