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Valutazione quantitativa dell’insufficienza mitralica Frank L Dini

MCV2 Pisa. Valutazione quantitativa dell’insufficienza mitralica Frank L Dini. Firenze, 30 Maggio 2008. Insufficienza Mitralica: Area Massima del Flusso Disturbato. >8 cm 2. Area del rigurgito in rapporto all’area dell’atrio sinistro. Lieve-Moderata 20-40%. Severa>40%.

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Valutazione quantitativa dell’insufficienza mitralica Frank L Dini

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  1. MCV2 Pisa Valutazione quantitativa dell’insufficienza mitralica Frank L Dini Firenze, 30 Maggio 2008

  2. Insufficienza Mitralica: Area Massima del Flusso Disturbato >8 cm2

  3. Area del rigurgito in rapporto all’area dell’atrio sinistro Lieve-Moderata 20-40% Severa>40%

  4. Correlazione tra dati eco-Doppler e dati angiografici Helmcke F, et al, Circulation 1987; 75: 175.

  5. Volume rigurgitante = area valvolare Insufficienza Mitralica: Fisiopatologia DP è il salto di pressione tra l’atrio sinistro e il ventricolo sinistro in sistole,  TS è la durata della sistole.

  6. Equazione di Continuità A1 A2 A1v1 A2= A1v1 = A2v2 v2

  7. Metodo delle Aree di Isovelocità Prossimale

  8. Q = ERO ● VRM Metodo delle Superfici Prossimali di Isovelocità

  9. ERORM (mm2) = (2pr2*Vr) ÷VRM Measurement of Mitral Effective Regurgitation Orifice (ERO) QR (cm3/sec) = 2pr2*Vr

  10. Severità dell’IM (ERORM) Angiografia ERORM Grado I/IV < 10 mm2 Grado II/IV 10-25 mm2 Grado III-IV/IV > 25-35 mm2 Rapporti tra Orifizio Regurgitante Effettivo (ERO) e Gravità dell’IM all’Angiografia

  11. Secondary Mitral Regurgitation: Long-term Prognosis 1.0 0.8 0.6 0.4 0.2 0.0 47 ± 8 P < 0.001 29 ± 9 ERO 1 – 19 mm2 ERO > 20 mm2 0 1 2 3 4 5 YEARS Grigioni F, et al, Circulation 2001; 103: 1759.

  12. Effetto Coanda

  13. Pitfalls • Inadeguato allineamento • Difetti nella misura dei diametri • Errata posizione del volume campione • Troppo pochi battiti analizzati • Spettro Doppler incompleto • Assunzione di un orifizio circolare • Insufficienza aortica significativa

  14. Insufficienza Mitralica: Vena Contracta

  15. Vena Contracta

  16. Severità dell’IM (Vena Contracta) Angiografia Vena contracta (mm) Grado I/IV < 3 mm Grado II/IV 3-5 mm Grado III-IV/IV > 6 mm Rapporti tra Ampiezza della Vena Contracta e Gravità dell’IM all’Angiografia

  17. Dini FL, al, Eur J Heart Fail 2008.

  18. RIGHT HEART CATHETERIZATION

  19. Mitral Regurgitation at Right Heart Catheterization and Echo-Doppler 90 38 35

  20. Flusso mitralico restrittivo

  21. Tricuspid Valve Trans-tricuspid pressure gradient

  22. Relationship between the degree of MR and PASP Enriquez-Sarano M, et al. JACC 1997;29:153

  23. Tricuspid Anular Plane Systolic Excursion Khaul S.et al. Am Heart J 1984;107:526-531

  24. TAPSE >14 mm TAPSE ≤14 mm Log-rank p =0.003 Dini FL, al, Am Heart J 2007:154: 172-179

  25. Resting versus Exercise Echocardiography: the Role of TAPSE Ennezat PV et al. Am Heart J 2008;155:752-757

  26. 0.01 LV EDV 1.0 (1.00-1.02) Predictors of Cardiac Deathat Multivariate Cox Proportional-Hazards Analysis Hazard Ratio (95% CI) P value 8.9 (2.9-27.2) <0.0001 TAPSE ≤14 mm Ennezat PV et al. Am Heart J 2008;155:752-757

  27. Correlations of Pro-BNP and Functional Mitral Regurgitation N =324 r =0.40 p <0.0001 Dini FL et al. Eur Heart J 2005;26:540.

  28. Correlates of MR grade and RV function with BNP Troughton RW et al. J Am Coll Cardiol 2004;43:416-422

  29. Dini FL, al, Am Heart J 2008 (in cds)

  30. N-proBNP ≤1230 rg/ml; VCW <0.3 cm N-proBNP ≤1230 rg/ml VCW ≥0.3 cm N-proBNP >1230 rg/ml; VCW <0.3 cm N-proBNP >1230 rg/ml VCW ≥0.3 cm N =334; Log-rank <0.0001 Dini FL, al, Am Heart J 2008 (in cds)

  31. The highest plasma levels of B-type natriuretic peptide were found in patients with left heart failure and concomitant right ventricular dysfunction Mariano-Goluart D. et al. Eur J Heart Fail 2003;5:481-488

  32. Incremental prognostic value of TAPSE and NT-proBNP in pts with more then mild MR p =0.001 p =0.007 p =0.026 Dini FL, al, Eur J Heart Fail 2008.

  33. Dini FL, al, Eur J Heart Fail 2008.

  34. MCV2 Pisa Valutazione quantitativa dell’insufficienza mitralica Frank L Dini Firenze, 30 Maggio 2008

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