Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans

Importance of convective and inertial forces during left ventricular filling

Michael S. Firstenberg, Pieter M. Vandervoort, Neil L. Greenberg, Nicholas G. Smedira, Patrick M. McCarthy, Mario J. Garcia, James D. Thomas

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVES: We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference. BACKGROUND: Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-mode provides a spatiotemporal representation of flow across the mitral valve. METHODS: In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements. RESULTS: From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([Δp(I)](max) = 1.78 ± 1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35 ± 0.24 vs. 0.81 ± 0.15, p < 0.0001). It also allowed an accurate approximation of the peak pressure difference ([Δp(C+I)](max), = 0.95 [Δp(cath)](max) + 0.24, r = 0.96, p < 0.001, error = 0.08 ± 0.54 mm Hg). CONCLUSIONS: Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmittal flow, which should improve the understanding of diastolic filling and function of the heart. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1942-1949
Number of pages8
JournalJournal of the American College of Cardiology
Volume36
Issue number6
DOIs
StatePublished - Nov 15 2000
Externally publishedYes

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Mitral Valve
Pressure
Color
Catheters
Atrial Pressure
Ventricular Pressure
Coronary Artery Bypass
Hemodynamics
Blood Pressure

ASJC Scopus subject areas

  • Nursing(all)

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Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans : Importance of convective and inertial forces during left ventricular filling. / Firstenberg, Michael S.; Vandervoort, Pieter M.; Greenberg, Neil L.; Smedira, Nicholas G.; McCarthy, Patrick M.; Garcia, Mario J.; Thomas, James D.

In: Journal of the American College of Cardiology, Vol. 36, No. 6, 15.11.2000, p. 1942-1949.

Research output: Contribution to journalArticle

Firstenberg, Michael S. ; Vandervoort, Pieter M. ; Greenberg, Neil L. ; Smedira, Nicholas G. ; McCarthy, Patrick M. ; Garcia, Mario J. ; Thomas, James D. / Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans : Importance of convective and inertial forces during left ventricular filling. In: Journal of the American College of Cardiology. 2000 ; Vol. 36, No. 6. pp. 1942-1949.
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abstract = "OBJECTIVES: We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference. BACKGROUND: Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-mode provides a spatiotemporal representation of flow across the mitral valve. METHODS: In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements. RESULTS: From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([Δp(I)](max) = 1.78 ± 1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35 ± 0.24 vs. 0.81 ± 0.15, p < 0.0001). It also allowed an accurate approximation of the peak pressure difference ([Δp(C+I)](max), = 0.95 [Δp(cath)](max) + 0.24, r = 0.96, p < 0.001, error = 0.08 ± 0.54 mm Hg). CONCLUSIONS: Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmittal flow, which should improve the understanding of diastolic filling and function of the heart. (C) 2000 by the American College of Cardiology.",
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T1 - Noninvasive estimation of transmitral pressure drop across the normal mitral valve in humans

T2 - Importance of convective and inertial forces during left ventricular filling

AU - Firstenberg, Michael S.

AU - Vandervoort, Pieter M.

AU - Greenberg, Neil L.

AU - Smedira, Nicholas G.

AU - McCarthy, Patrick M.

AU - Garcia, Mario J.

AU - Thomas, James D.

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Y1 - 2000/11/15

N2 - OBJECTIVES: We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference. BACKGROUND: Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-mode provides a spatiotemporal representation of flow across the mitral valve. METHODS: In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements. RESULTS: From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([Δp(I)](max) = 1.78 ± 1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35 ± 0.24 vs. 0.81 ± 0.15, p < 0.0001). It also allowed an accurate approximation of the peak pressure difference ([Δp(C+I)](max), = 0.95 [Δp(cath)](max) + 0.24, r = 0.96, p < 0.001, error = 0.08 ± 0.54 mm Hg). CONCLUSIONS: Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmittal flow, which should improve the understanding of diastolic filling and function of the heart. (C) 2000 by the American College of Cardiology.

AB - OBJECTIVES: We hypothesized that color M-mode (CMM) images could be used to solve the Euler equation, yielding regional pressure gradients along the scanline, which could then be integrated to yield the unsteady Bernoulli equation and estimate noninvasively both the convective and inertial components of the transmitral pressure difference. BACKGROUND: Pulsed and continuous wave Doppler velocity measurements are routinely used clinically to assess severity of stenotic and regurgitant valves. However, only the convective component of the pressure gradient is measured, thereby neglecting the contribution of inertial forces, which may be significant, particularly for nonstenotic valves. Color M-mode provides a spatiotemporal representation of flow across the mitral valve. METHODS: In eight patients undergoing coronary artery bypass grafting, high-fidelity left atrial and ventricular pressure measurements were obtained synchronously with transmitral CMM digital recordings. The instantaneous diastolic transmitral pressure difference was computed from the M-mode spatiotemporal velocity distribution using the unsteady flow form of the Bernoulli equation and was compared to the catheter measurements. RESULTS: From 56 beats in 16 hemodynamic stages, inclusion of the inertial term ([Δp(I)](max) = 1.78 ± 1.30 mm Hg) in the noninvasive pressure difference calculation significantly increased the temporal correlation with catheter-based measurement (r = 0.35 ± 0.24 vs. 0.81 ± 0.15, p < 0.0001). It also allowed an accurate approximation of the peak pressure difference ([Δp(C+I)](max), = 0.95 [Δp(cath)](max) + 0.24, r = 0.96, p < 0.001, error = 0.08 ± 0.54 mm Hg). CONCLUSIONS: Inertial forces are significant components of the maximal pressure drop across the normal mitral valve. These can be accurately estimated noninvasively using CMM recordings of transmittal flow, which should improve the understanding of diastolic filling and function of the heart. (C) 2000 by the American College of Cardiology.

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