Left ventricular performance in mitral regurgitation assessed with systolic time intervals and echocardiography

Abstract

Among 22 patients with isolated mitral regurgitation of various origins, systolic time intervals (preejection period [PEP] index, left ventricular ejection time [LVET] index and PEP/LVET) and echocardiographic measures of left ventricular performance (end-diastolic diameter [Dd], end-systolic diameter [Ds], and the percent change in minor axis diameter [% delta D]) were calculated. The patients were classified into two groups, those with a normal or supernormal % delta D (group I, 15 patients) and those with a decreased % delta D (group II, 7 patients). On group analysis, prolongation of the preejection period, shortening of the left ventricular ejection time and an increase in PEP/LVET was generally characteristic of patients with mitral regurgitation. These changes were accentuated when mitral regurgitation was complicated by echocardiographic evidence of diminished left ventricular contractile performance (% delta D less than 30 percent). An increase in PEP/LVET to greater than 0.05 was consistently associated with abnormal left ventricular performance, whereas a normal PEP/LVET ratio reflected normal or supernormal left ventricular performance. An inverse linear relation was found between PEP/LVET and % delta D. When compared with previous data on the relation of these variables among patients without valve insufficiency, PEP/LVET proved to be increased for any level of % delta D in mitral regurgitation. The state of digitalization did not appear to influence the relation between PEP/LVET and % delta D. The use of echocardiographic measurements augments the determination of systolic time intervals in the analysis of left ventricular performance in patients with mitral regurgitation.