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Factors Responsible for Left Ventricular Underfilling in Pure Mitral Stenosis

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Mechanisms of Heart Failure

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 167))

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Summary

Our aim was to estimate factors influencing left ventricular (LV) end-diastolic volume index (EDVI) and stroke volume index (SVI) in pure mitral stenosis (MS) with preserved sinus rhythm. We analyzed the records of 42 patients (aged 20-40 years) with isolated MS in sinus rhythm who underwent routine diagnostic cardiac catheterization. The group was divided into two subgroups, A and B [those with an EDVI below and above its mean value (71.2 ml/m2), respectively]. In the whole group, SVI and EDVI were strongly correlated (r = 0.84, p < 0.0001), whereas no correlation between SVI and end-systolic volume index (ESVI) was found. As compared with group B, group A subjects had significantly lower SVI, EDVI, ESVI, ejection fraction, and LV minimal pressure as well as a higher heart rate and LV chamber stiffness constant. Group A also exhibited an insignificant tendency to higher pulmonary pressures and pulmonary vascular resistance. Groups A and B had similar values of all other analyzed variables, including mitral valve area. We conclude that LV underfilling in pure MS is related not only to a narrowed mitral orifice but also to other factors.

As compared with healthy subjects, left ventricular (LV) end-diastolic volume (EDV) was shown to be decreased [1,2], normal [3], or increased [4,5] in isolated mitral stenosis (MS), which indicates a large relative interindividual variability of EDV in this disease. Assuming that LV underfilling would be the principal determinant of low EDV in MS, the MS subjects with depressed LV stroke volume (SV) would be those with a low EDV. The importance of EDV as a marker of LV underfilling has been reinforced by the fact that percutaneous balloon mitral valvuloplasty results in acute EDV and SV increases only in subjects with an EDV lower than 100 ml [2]. In addition, Goto et al. [6] revealed a close correlation between SV and EDV in pure MS both before and after valvuloplasty. However, this does not exclude the possibility that in some MS patients intrinsic abnormality of LV contraction and/or increased afterload may result in a secondary increase in EDV so that EDV does not reflect LV underfilling but instead exhibits a compensatory rise aimed at counteracting the SV depression [4,5,7]. The aim of the present study was to estimate factors influencing EDV and SV in pure MS with preserved sinus rhythm.

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Authors
  1. Andrzej Surdacki
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  2. Jacek Legutko
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  3. Paweł Turek
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  4. Dariusz Dudek
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  5. Krzysztof Żmudka
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  6. Jacek S. Dubiel
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Editors and Affiliations

  1. MRC Group in Experimental Cardiology Division of Cardiovascular Sciences St. Boniface General Hospital Research Centre Faculty of Medicine, University of Manitoba, Winnipeg, Canada

    Pawan K. Singal , Ian M. C. Dixon , Robert E. Beamish  & Naranjan S. Dhalla , ,  & 

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© 1995 Springer Science+Business Media New York

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Surdacki, A., Legutko, J., Turek, P., Dudek, D., Żmudka, K., Dubiel, J.S. (1995). Factors Responsible for Left Ventricular Underfilling in Pure Mitral Stenosis. In: Singal, P.K., Dixon, I.M.C., Beamish, R.E., Dhalla, N.S. (eds) Mechanisms of Heart Failure. Developments in Cardiovascular Medicine, vol 167. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-2003-0_10

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  • DOI: https://doi.org/10.1007/978-1-4615-2003-0_10

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-5827-5

  • Online ISBN: 978-1-4615-2003-0

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