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The determinants of systolic pulmonary venous flow reversal by transthoracic pulsed Doppler in mitral regurgitation: its value in determining the severity of regurgitation

Objective — Systolic pulmonary venous flow reversal (SPVFR) has been evaluated in mitral regurgitation (MR) primarily by transoesophageal echocardiography (TEE). There is limited study on the value of SPVFR obtained from transthoracic echocardiography (TTE) for the quantification of MR. In this study, determinants of SPVFR and the accuracy of SPVFR obtained with TTE in determining the severity of MR were investigated. Methods and results — Fifty patients with MR in whom reference quantitative Doppler evaluation was carried out formed the study group. Thirty-nine of them underwent cardiac catheterization. In all patients, SPVFR was evaluated by pulsed Doppler echo placed both at the right and left pulmonary vein in the apical four-chamber view. The SPVFR was present in 26 (52%) patients. Atrial fibrillation, and grade III-IV MR by catheterization were more frequent in patients who had SPVFR. Patients with SPVFR had increased values for regurgitant orifice area, regurgitant volume, regurgitant fraction, and left atrium/left ventricle diameters and volumes compared to patients without SPVFR. After multivariate analysis regurgitant fraction (RF) was the single and most powerful determinant of SPVFR (p<0.001).The SPVFR had high sensitivity, specificity and accuracy for the diagnosis of severe MR (89, 95 and 92%, respectively). Conclusion — It was concluded that SPVFR is a useful method for the evaluation of the severity of mitral regurgitation.