This study aimed to investigate the utility of transthoracic echocardiographic (TTE)
Doppler-derived parameters in detection of mitral prosthetic dysfunction and to define
optimal cut-off values for identification of such dysfunction by valve type. In total,
971 TTE studies (647 mechanical prostheses; 324 bioprostheses) were compared with
transesophageal echocardiography for evaluation of mitral prosthesis function. Among
all prostheses, mitral valve prosthesis (MVP) ratio (ratio of time velocity integral
of MVP to that of left ventricular outflow tract; odds ratio [OR] 10.34, 95% confidence
interval [95% CI] 6.43 to 16.61, p<0.001), E velocity (OR 3.23, 95% CI 1.61 to 6.47,
p<0.001), and mean gradient (OR 1.13, 95% CI 1.02 to 1.25, p=0.02) provided good discrimination
of clinically normal and clinically abnormal prostheses. Optimal cut-off values by
receiver operating characteristic analysis for differentiating clinically normal and
abnormal prostheses varied by prosthesis type. Combining MVP ratio and E velocity
improved specificity (92%) and positive predictive value (65%) compared with either
parameter alone, with minimal decline in negative predictive value (92%). Pressure
halftime (OR 0.99, 95% CI 0.98 to 1.00, p=0.04) did not differentiate between clinically
normal and clinically abnormal prostheses but was useful in discriminating obstructed
from normal and regurgitant prostheses. In conclusion, cut-off values for TTE-derived
Doppler parameters of MVP function were specific to prosthesis type and carried high
sensitivity and specificity for identifying prosthetic valve dysfunction. MVP ratio
was the best predictor of prosthetic dysfunction and, combined with E velocity, provided
a useful parameter for determining likelihood of dysfunction and need for further
assessment.
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Article Info
Publication History
Published online: July 25, 2017
Accepted:
July 12,
2017
Received:
April 24,
2017
Footnotes
Dr. SA Luis is formerly of The Prince Charles Hospital, Brisbane, Australia.
See page 1379 for disclosure information.
Identification
Copyright
Crown Copyright © 2017 Published by Elsevier Inc. All rights reserved.
