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Biomedical subjects

A J Labovitz

Publications and source records attributed to A J Labovitz.

At least 91 records · Page 5Linked to original sources
PubMed1989

Usefulness of Doppler echocardiography in the diagnosis of congestive heart failure.

One hundred fifty-one consecutive patients with a diagnosis of congestive heart failure (CHF) referred for echocardiography were prospectively evaluated to (1) define the frequency of normal left ventricular systolic function in a referral-based population with CHF; (2) establish cardiac mechanisms responsible for symptomatology in these patients; and (3) assess the ability to clinically differentiate these subsets of patients based on routine history and physical examination. Of the 151 total patients, 51 (34%) had normal left ventricular systolic function (left ventricular ejection fraction greater than or equal to 55%). Primary valvular disease was present in 4 of these 51 patients (8%), and Doppler echocardiographic evidence of abnormal left ventricular filling (diastolic dysfunction) was evident in 10 (20%). In addition, no predefined resting abnormality was noted in 34 (66%) of them. Despite this finding, 51% of all patients with normal left ventricular systolic function were being treated with digoxin therapy in the absence of atrial arrhythmia. Clinical differentiation of this group of patients from those with abnormal left ventricular systolic function was difficult and may have accounted for this apparently inappropriate treatment. Thus, evaluation of left ventricular function and of causative mechanisms of CHF before initiation of long-term treatment is mandatory.

Adult↗
PubMed1989

The effect of premature ventricular contraction on left ventricular relaxation, chamber stiffness, and filling in humans.

To investigate the influence of single spontaneous premature ventricular ectopic beats on left ventricular contraction, relaxation, chamber stiffness, and filling, we examined 21 patients with simultaneous micromanometer left ventricular pressure tracings and echocardiograms. Instantaneous left ventricular diameter and mitral valve inflow velocity were obtained by using of M-mode and pulsed Doppler echocardiography, respectively. The isovolumic relaxation time constants (TL and TD) were calculated by mean of a zero (TL) and variable (TD) asymptote pressure. The chamber stiffness constants were derived from the diastolic pressure-diameter (kd) and pressure-volume (kv) relationships. The extrasystolic beat was associated with marked impairments of relaxation, systolic function, and diastolic filling as seen by an increased TL (53 to 71 msec; p less than 0.001), TD (59 to 89 msec; p less than 0.005), time from maximum negative dp/dt to the lowest diastolic pressure (147 to 170 msec; p less than 0.05), and decreased number of elasped TDs (3.1 to 2.4; p less than 0.05), end-systolic pressure-diameter ratio (2.4 to 1.7; p less than 0.001), maximum positive dp/dt (1904 to 1326 mm Hg/sec; p less than 0.001), shortening fraction (31% to 21%; p less than 0.001), and peak early filling velocity (59 to 49 cm/sec; p less than 0.001). Chamber stiffness constants were unchanged. Relaxation and chamber stiffness were unchanged during the postextrasystolic beat as reflected by TL, TD, maximum negative dp/dt, and kd and kv.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Noninvasive assessment of diastolic and systolic properties of ibopamine in patients with congestive heart failure.

The acute effect of a single oral 100 mg dose of ibopamine on systolic and diastolic left ventricular function in nine patients with congestive heart failure was assessed by quantitative M-mode and pulsed Doppler echocardiography. Echocardiography was performed at baseline and 30, 60, and 120 minutes after ingestion of drug. Indices of systolic and diastolic left ventricular function were derived from digitized tracings of the septal and posterior endocardial surfaces and transmitral and aortic valve velocity profiles. Ibopamine significantly improved systolic function as reflected by a decrease in the preejection period to left ventricular ejection time ratio from 0.57 +/- 0.16 at baseline to 0.47 +/- 0.15 (p less than 0.05) 30 minutes after ingestion of drug. The maximum improvements in stroke volume and cardiac output after ibopamine were from 63 +/- 35 to 72 +/- 40 ml (p less than 0.05) and 4.6 +/- 1.7 to 5.4 +/- 2.1 L/min (p = 0.05), respectively. The contribution of atrial systole to total diastolic filling increased from 32 +/- 10% at baseline to 37 +/- 12% (p less than 0.05) after 30 minutes and persisted for at least 120 minutes. The distribution of diastolic filling was significantly altered after ingestion of ibopamine as reflected by a decrease in the ratio of the time-velocity integrals of left ventricular filling during early diastole and atrial systole (Ei/Ai) from 2.44 +/- 1.08 at baseline to 1.98 +/- 0.97 (p less than 0.05) 30 minutes after drug. The decrease in the Ei/Ai persisted for at least 120 minutes. The duration of the effect of ibopamine on diastolic filling persisted longer than its effect on augmenting systolic function. The positive effect of ibopamine on systolic function makes it a promising drug in the treatment of congestive heart failure.

Adult↗
PubMed1989

The effects of successful PTCA on left ventricular function: assessment by exercise echocardiography.

To assess the usefulness of exercise echocardiography in the follow-up of patients after percutaneous transluminal coronary angioplasty (PTCA), we studied 56 patients at rest and immediately following exercise with two-dimensional echocardiography. Sixty-nine of 73 stress/echo studies (94%) were suitable for interpretation. Seventeen patients (group I) with significant coronary artery disease (CAD) were studied before and after PTCA. Sixteen patients with coronary disease not undergoing PTCA (group II) and 23 individuals without significant coronary disease (group III) served as age-matched controls. Left ventricular ejection fraction did not change significantly in group I patients prior to PTCA (56 +/- 7 versus 54 +/- 12, p = ns) or in group II patients (52 +/- 10 versus 56 +/- 15, p = ns), rest versus immediate after exercise measurements. Following angioplasty, left ventricular ejection fraction increased in group I patients from 55 +/- 7 to 65 +/- 8, p less than 0.001 from rest to exercise, and to a similar extent in group III individuals (55 +/- 6 to 66 +/- 8, p less than 0.001). Electrocardiographic (ECG) evidence of ischemia (greater than 1 mm ST segment depression) was found in 13 of 17 group I patients prior to PTCA and in 8 of 16 group II patients (CAD). None of the 25 normal patients and four of the group I patients following PTCA had abnormal ECG changes with exercise. New exercise-induced echocardiographic wall motion abnormalities were found in 12 of 17 group I patients prior to PTCA and in none of the group I patients following PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1989

The hemodynamic benefit of differential atrioventricular delay intervals for sensed and paced atrial events during physiologic pacing.

The ability to program different atrioventricular (AV) delay intervals for paced and sensed atrial events is incorporated in the design of some newer dual chamber pacemakers. However, little is known regarding the hemodynamic benefit of differential AV delay intervals or the magnitude of difference between optimal AV delay intervals for paced and sensed P waves in individual patients. In this study, Doppler-derived cardiac output was used to examine the optimal timing of paced and sensed atrial events in 24 patients with a permanent dual chamber pacemaker. The hemodynamic effect of utilizing separate optimal delay intervals for sensed and paced events compared with utilizing the same fixed AV delay interval for both was determined. The optimal delay interval during DVI (AV sequential) pacing and VDD (atrial triggered, ventricular inhibited) pacing at similar heart rates was 176 +/- 44 and 144 +/- 48 ms (p less than 0.002), respectively. The mean difference between the optimal AV delay intervals for sensed (VDD) and paced (DVI) P waves was 32 ms and was up to 100 ms in some individuals. The difference between optimal AV delay intervals for sensed and paced atrial events was similar in patients with complete heart block and those with intact AV node conduction. At the respective optimal AV delay intervals for sensed and paced P waves, there was no significant difference in the cardiac output during VDD compared with DVI pacing. However, cardiac output significant declined during VDD pacing at the optimal AV delay interval for a paced event and during DVI pacing at the optimal interval for a sensed event.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Effects of pharmacologic coronary hyperemia on echocardiographic left ventricular function in patients with single vessel coronary artery disease.

To assess whether pharmacologic coronary vasodilation could provoke new left ventricular wall motion abnormalities in patients with single vessel coronary artery disease, systemic hemodynamics, coronary blood flow velocity and left ventricular wall motion were measured by two-dimensional echocardiography during administration of 10 mg of intracoronary papaverine in 14 patients before and again immediately after left coronary angioplasty (group 1). As a comparison with an intravenous method, left ventricular wall motion was analyzed after 0.56 mg/kg body weight of intravenous dipyridamole in a separate group of 13 patients with single vessel coronary disease (group 2). Heart rate-blood pressure product increased 3% to 6% in papaverine-treated patients and 14 +/- 11% (p = NS) in dipyridamole-treated patients. No angiographic collateral vessels were present in either group. Although intracoronary mean flow velocity measured in the 14 group 1 patients and in 5 normal control subjects during papaverine treatment increased from 125% to 400% of basal flow velocity, papaverine induced new left ventricular wall motion abnormalities in only 5 of the 14 patients before coronary angioplasty. In three of five patients, left ventricular wall motion abnormalities persisted after successful coronary angioplasty. Four of the 14 patients demonstrated augmentation of left ventricular wall motion with papaverine. After intravenous dipyridamole, only 3 of the 13 group 2 patients developed new left ventricular regional asynergy. These data suggest that selective (papaverine) and, most likely, global (dipyridamole) augmentation of coronary flow alone does not reliably identify potential ischemic left ventricular regions affected by critical single vessel coronary artery disease.

Angiography↗
PubMed1989

Hemodynamic benefit of atrioventricular synchrony: prediction from baseline Doppler-echocardiographic variables.

The purpose of this study was to determine if baseline Doppler-echocardiographic variables of systolic or diastolic function could predict the hemodynamic benefit of atrioventricular (AV) synchronous pacing. Twenty-four patients with a dual chamber pacemaker were studied. Baseline M-mode and two-dimensional echocardiograms were obtained and Doppler-echocardiographic measurements of mitral inflow and left ventricular outflow were made in VVI mode (single rate demand) and in VDD (atrial synchronous, ventricular inhibited) and DVI (AV sequentially paced) modes at AV intervals ranging from 50 to 300 ms. Forward stroke volume and cardiac output were determined in each mode at each AV interval from the left ventricular outflow tract flow velocities, and the percent increase in cardiac output over VVI mode was determined. M-mode measurements, including left ventricular end-diastolic dimension, shortening fraction and left atrial size and Doppler measurement of diastolic filling, including peak early velocity and percent atrial contribution, did not correlate with the percent increase in cardiac output during physiologic pacing. The stroke volume in VVI mode correlated significantly with the percent increase in cardiac output during physiologic pacing (r = -0.61, p less than 0.005 for VDD mode and r = -0.55, p less than 0.05 for DVI mode). Five of the 15 patients with VVI stroke volume less than 50 ml but none of the 9 patients with stroke volume greater than 50 ml had ventriculoatrial (VA) conduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Left ventricular diastolic function: comparison of pulsed Doppler echocardiographic and hemodynamic indexes in subjects with and without coronary artery disease.

To evaluate the influence of left ventricular chamber stiffness and relaxation on Doppler echocardiographic indexes of diastolic function, 35 patients (mean age 60 +/- 12 years) were examined; 24 had coronary artery disease and 11 (Group I) had no cardiovascular disease. Micromanometer left ventricular pressure was recorded simultaneously with Doppler echocardiograms of mitral valve inflow and M-mode echocardiograms of left ventricular diameter. The chamber stiffness constant (k) was derived from the pressure-diameter relation. Relaxation was assessed by the isovolumic relaxation time constant (tau) derived from the exponential left ventricular pressure decay. The patients with coronary artery disease were classified into two groups on the basis of complete (Group II; n = 10) and incomplete (Group III; n = 14) relaxation. In Group I (no coronary disease), significant correlations were demonstrated between the chamber stiffness constant and the peak early filling velocity (r = 0.73; p less than 0.02), peak early to atrial filling velocity ratio (r = 0.82; p less than 0.005), atrial time-velocity integral (r = -0.73; p less than 0.02), early to atrial time-velocity integral ratio (r = 0.70; p less than 0.05), percent atrial contribution to filling (r = -0.64; p less than 0.05) and one-half filling fraction (r = 0.73; p less than 0.02). In Group II (coronary disease with complete relaxation), the chamber stiffness constant correlated with peak early filling velocity (r = 0.68; p less than 0.05), early filling time-velocity integral (r = 0.65; p less than 0.05) and early to atrial time-velocity integral ratio (r = 0.74; p less than 0.02). No correlations between k and Doppler indexes were found in Group III (coronary disease with incomplete relaxation). However, Group III demonstrated significant correlations between tau and the peak early filling velocity (r = -0.71; p less than 0.005), percent atrial contribution to filling (r = 0.56; p less than 0.05) and mean acceleration rate of early filling (r = -0.79; p less than 0.002). Thus, in subjects with normal relaxation, increasing chamber stiffness was associated with an enhanced peak early filling velocity and volume and decreased filling during atrial systole. This finding differs strikingly from the proposed influence of chamber stiffness on diastolic filling postulated by several researchers.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

Influence of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiography in humans.

We examined the influence of alterations in preload on pulsed Doppler indexes of left ventricular diastolic function in 50 patients including 12 without cardiovascular disease, 29 with coronary artery disease, and nine with critical aortic stenosis. Micromanometer left ventricular pressure was recorded simultaneously with pulsed Doppler echocardiography of left ventricular inflow and M-mode echocardiography of left ventricular diameter. Chamber stiffness constants, kd and kv, were obtained from the diastolic pressure-diameter and pressure-volume relations, respectively. Relaxation was measured by the isovolumic relaxation time constants, TL and TD, derived from the exponential left ventricular pressure decay and maximum negative dP/dt. In 41 patients after nitroglycerin treatment, left ventricular end-diastolic pressure decreased from 18 +/- 5 to 13 +/- 4 mm Hg (p less than 0.001). The ratio of peak early to peak atrial filling velocities and time-velocity integral ratios decreased from 1.08 +/- 0.57 to 0.90 +/- 0.42 (p less than 0.001) and from 1.77 +/- 0.95 to 1.41 +/- 0.71 (p less than 0.001), respectively. The peak early filling velocity and time-velocity integral decreased from 56.1 +/- 15.7 to 49.9 +/- 14.5 cm/sec (p less than 0.001) and from 7.9 +/- 2.7 to 6.8 +/- 2.8 cm (p less than 0.001), respectively. Relaxation (TL, TD, and maximum negative dP/dt) and chamber stiffness (kd and kv) were not impaired after nitroglycerin administration. In 48 patients after ventriculography, left ventricular end-diastolic pressure increased from 18 +/- 6 to 22 +/- 8 mm Hg (p less than 0.001). The peak early and peak atrial filling velocities increased from 57.4 +/- 15.2 to 68.3 +/- 19.7 cm/sec (p less than 0.001) and from 61.0 +/- 22.7 to 69.4 +/- 23.2 cm/sec (p less than 0.01), respectively. As a result, the ratio of peak early to peak atrial filling velocity was unchanged. However, in the aortic stenosis group, the ratio of peak early to peak atrial filling velocity increased from 0.95 +/- 0.64 to 1.10 +/- 0.72 (p less than 0.02). Relaxation and chamber stiffness were unchanged. Thus, a reduction or increase in preload may induce a diastolic filling pattern that mimics or masks diastolic dysfunction, respectively. Preload conditions need to be accounted for when the status of diastolic function is extrapolated from the pulsed Doppler mitral inflow velocity profile.

Aortic Valve Stenosis↗
PubMed1989

Assessment of prosthetic heart valve function by Doppler echocardiography. A decade of experience.

Since the first report of the application of Doppler echocardiography in the evaluation of prosthetic heart valves 10 years ago, dozens of studies have reaffirmed the usefulness of this technique in the noninvasive assessment of transvalvular hemodynamics. Most of these studies have established "normal values" for Doppler-determined pressure gradients and valve areas of prosthetic mitral and aortic valves. Although these studies have established the "normal range," they have all emphasized the individual variability in clinically normal functioning valves. Most of these studies have confirmed the extraordinary sensitivity and specificity of Doppler in detecting prosthetic valve dysfunction. The study by Burstow et al further emphasizes the excellent correlation obtained with simultaneous Doppler and catheter transvalvular pressure gradient measurements. The addition of both color flow Doppler techniques and transesophageal echocardiography can only serve to enhance the clinical diagnostic accuracy of this technique. At the present time, Doppler echocardiography is clearly the procedure of choice for the evaluation of the patient with suspected prosthetic heart valve dysfunction.

Echocardiography, Doppler↗
PubMed1989

Rest and exercise evaluation of St. Jude Medical and Medtronic Hall prostheses. Influence of primary lesion, valvular type, valvular size, and left ventricular function.

To compare St. Jude Medical and Medtronic Hall mechanical prosthetic heart valves, we prospectively randomized 90 consecutive patients requiring mechanical valve replacement and studied their rest and exercise hemodynamics by Doppler echocardiography. Fifty-six aortic and 42 mitral valves were implanted. All patients were examined preoperatively and postoperatively, and follow-up studies were obtained at rest and immediately after upright, treadmill exercise at 6 months (n = 68). Clinical parameters (mortality, morbidity, and congestive heart failure classification), as well as rest and exercise hemodynamics (valvular area, gradients, and left ventricular ejection fraction), were examined, and their relation to exercise duration was defined. Mortality (perioperative, 8.8% and late, 2.4%) was similar between patients in the two valve groups (five in each group). There was one late thromboembolic episode with each valve. Improvement in New York Heart Association congestive heart failure class was seen in 85% of patients at 6 months. There were no significant differences in calculated aortic valve areas (2.2 vs. 2.0 cm2), resting (24 vs. 21 mm Hg) and exercise (41 vs. 35 mm Hg) peak aortic gradients, and exercise duration between patients with the St. Jude Medical and Medtronic Hall aortic prostheses. In patients with aortic prostheses, valvular size was correlated with exercise duration (r = 0.41, p less than 0.05). In patients with mitral prostheses, we observed no significant differences between St. Jude Medical and Medtronic Hall prostheses in calculated mitral valve areas (3.4 cm2 vs. 3.4 cm2) and rest (2.5 vs. 3.0 mm Hg) and exercise (5.1 vs. 7.0 mm Hg) mean gradients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Doppler and two-dimensional echocardiographic assessment of left ventricular function before and after intravenous dipyridamole stress testing for detection of coronary artery disease.

Thallium perfusion imaging following the intravenous infusion of dipyridamole, a potent coronary vasodilator, has been demonstrated to be useful in the evaluation of the functional significance of coronary artery disease (CAD). While recent studies have demonstrated that 2-dimensional echocardiographic monitoring of left ventricular (LV) function after intravenous dipyridamole has a sensitivity somewhat less than that of thallium perfusion imaging, none has examined the usefulness of Doppler evaluation of aortic blood flow in this setting. One hundred patients undergoing dipyridamole-thallium imaging for clinical indications were studied. Technically adequate Doppler echocardiographic studies were obtained in 97 patients. LV ejection fraction, peak aortic velocity and acceleration, as well as segmental LV wall motion, were analyzed before and at peak dipyridamole effect. Thallium perfusion images were normal in 41 and abnormal in 53 patients studied. A statistically significant difference in percent change from baseline to peak dipyridamole effect in velocity, acceleration and ejection fraction was seen between the 2 groups (26 vs -2%, 51 vs -2% and 16 vs 4%, respectively, all p less than 0.05). Comparison of 2-dimensional wall motion analysis to thallium yielded a sensitivity and specificity of 74 and 80%, respectively. In the group of patients who underwent cardiac catheterization, 2-dimensional wall motion analysis yielded a sensitivity of 64% in the detection of CAD. The combination of 2-dimensional and Doppler echocardiographic parameters increased the sensitivity in the detection of CAD to 85%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Comparison of pulsed Doppler echocardiography and radionuclide angiography in the assessment of left ventricular filling.

To determine the relation between Doppler echocardiographic and radionuclide angiographic indexes of left ventricular (LV) filling, 42 patients were studied using both techniques. From Doppler mitral flow velocity profiles, the percent of LV filling due to atrial systole (percent atrial contribution) and at one-third of diastole (one-third filling fraction), the peak filling rate and the peak filling rate normalized for LV end-diastolic volume and the time from mitral valve opening to peak early velocity and from aortic valve closure to peak early velocity were determined. Good correlations were found between percent atrial contribution (r = 0.83) and one-third filling fraction (r = 0.67) using the 2 techniques. However, Doppler normalized peak filling rate correlated only weakly with radionuclide peak filling rate (r = 0.33, p less than 0.05). There was no significant correlation between Doppler peak filling rate and radionuclide peak filling rate. Neither Doppler time from mitral valve opening to peak early velocity nor Doppler time from aortic closure to peak early velocity correlated with radionuclide time to peak filling rate. Thus, Doppler echocardiography and radionuclide angiography agree on relative diastolic filling indexes but not on peak filling rates or useful diastolic time intervals. Relative filling indexes, such as percent atrial contribution and one-third filling fractions, therefore, may be the most reliable noninvasive indicators of diastolic function.

Echocardiography↗
PubMed1988

Effects of electrophysiologic studies resulting in electrical countershock or burst pacing on left ventricular systolic and diastolic function.

To determine the acute effects of electrophysiologic study on left ventricular systolic and diastolic function in patients requiring termination of induced tachyarrhythmias by either electrical countershock or burst pacing, we examined 16 patients (11 men and five women), aged 43 to 78 years (mean 58 +/- 13), undergoing programmed electrical stimulation. Indices of systolic and diastolic left ventricular function were measured by M-mode echocardiography before and within 1 minute after termination of 22 episodes of induced tachyarrhythmias by defibrillation (n = 16) and burst pacing (n = 6). The left ventricular septal and posterior endocardial surfaces were digitized immediately below the mitral valve leaflets, and indices of systolic and diastolic function were calculated. The results showed a significant impairment in both systolic and diastolic function after termination of tachyarrhythmias by defibrillation, as seen by a decrease in the shortening fraction (23.7 +/- 7.6% to 19.8 +/- 7.8%; p less than 0.005) and a decline in the peak rate of increase in left ventricular diameter during diastole called dD/dtmax (87.4 +/- 36.1 mm/sec to 71.5 +/- 28.9 mm/sec; p less than 0.01), respectively. In addition, indices of systolic and diastolic function measured at baseline were predictive of impairment in diastolic function, as seen by modest but highly significant correlations between the absolute change in dD/dtmax after defibrillation versus the peak velocity of fiber shortening (r = -0.69; p less than 0.005) and dD/dtmax (r = -0.60; p less than 0.02) measured at baseline. Left ventricular function after termination of tachyarrhythmias by burst pacing was not significantly altered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Doppler echocardiographic assessment of the effect of varying atrioventricular delay and pacemaker mode on left ventricular filling.

Pulsed Doppler echocardiography was used to study the timing and dynamics of left ventricular filling in 14 patients with permanent dual-chamber programmable pacemakers. Pacemakers were programmed to atrial sensed (VDD) mode and atrial-ventricular sequential paced mode at low (DVI-L) and high (DVI-H) heart rates, and pulsed Doppler recordings of transmitral flow were analyzed at atrioventricular delays of 50 to 300 msec in each mode. There was a significant decrease in the one-third filling fraction in both VDD and DVI-L modes and a significant increase in DVI-H modes with increasing atrioventricular delay. The ratio of early filling area to atrial filling area was significantly lower at longer atrioventricular delays in both VDD and DVI-L modes. The time from pacemaker spike to mitral valve closure was highly significantly correlated with atrioventricular delay in VDD, DVI-L, and DVI-H modes (r = -0.92, p = 0.0001; r = -0.90, p = 0.0001; and r = -0.85, p = 0.0001, respectively) as was the diastolic filling time to a lesser extent (r = -0.73, p = 0.0001; r = -0.69, p = 0.0001; r = -0.61, p = 0.0001, respectively). Events reflecting atrial systole occurred at a later time in the cardiac cycle in the atrial paced vs the atrial sensed mode. Thus changes in atrioventricular delay and pacemaker mode in this group of patients are a strong determinant of the timing and dynamics of left ventricular filling.

Aged↗
PubMed1988

Clinical significance of the echocardiographic degree of mitral valve prolapse.

To assess the clinical significance of the echocardiographic degree of mitral valve prolapse, we prospectively evaluated with Doppler echocardiography 245 consecutive patients referred with signs or symptoms consistent with a diagnosis of mitral valve prolapse. The echocardiographic degree of mitral valve prolapse was measured by a scoring system that incorporates an assessment of mitral systolic displacement from the M-mode as well as the two-dimensional long-axis and apical four-chamber views (range 0 to 9, 0 = no mitral valve prolapse). A structured questionnaire was used to record the frequency and severity of symptoms. Pulsed and continuous-wave Doppler echocardiography were performed to document mitral regurgitation and determine the ratio of peak early to atrial diastolic filling velocities. Patients were grouped according to the degree of mitral valve prolapse; 45 patients had no echocardiographic evidence of mitral valve prolapse. There was no statistically significant relationship between the mitral valve prolapse score and symptoms or left ventricular systolic or diastolic function. There was, however, a strong relationship between the echocardiographic degree of mitral valve prolapse and the presence of significant mitral regurgitation. Patients without echocardiographic evidence of mitral valve prolapse had a 4% incidence of mitral regurgitation, which was not significantly different than that of persons with mild degrees of prolapse (6%). However, the groups with the most marked degree of prolapse (scores of 6, 7, 8, and 9) had a significantly higher incidence of mitral regurgitation (20% and 60% respectively, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗