Time Difference Between Mitral And Tricuspid Opening Has A Prognostic Value In Patients With Heart Failure

Introduction: It is certain that comprehensive noninvasive assessment of LV and RV hemodynamics is valuable in the management of patients with heart failure (HF); however, the value of the noninvasive bi-ventricular hemodynamic assessment has been hampered by methodological limitations. Dual Doppler echocardiography was used to overcome the limitations by measuring a time difference between the mitral and tricuspid valve opening (MO-TO time) in a real-time fashion. Hypothesis: We hypothesized that MO-TO time was of additive prognostic value in patients with HF. Methods: We prospectively enrolled 60 patients with sinus rhythm who were admitted because of worsening of HF and underwent an invasive hemodynamic study after stabilization of the acute phase of HF. MO-TO time was measured in addition to routine echo parameters, invasive hemodynamic parameters and plasma BNP level in all patients. Patients were divided into either of two groups based on the MO-TO time: MOP (MO precedes to TO), and TOP (TO precedes to MO) groups. We followed up the predefined adverse outcome, cardiovascular death, and hospitalization due to worsening HF in all patients for a year. Results: The pulmonary artery wedge pressure (PAWP) and mean pulmonary artery pressure (mPAP) were higher in the MOP group than in the TOP group (21 ± 8.5 vs. 11 ± 4.5 mmHg, p < 0.001; 32 ± 8.8 vs. 21 ± 5.5, p < 0.001), respectively. PAWP and mPAP correlated with the MO-TO time (r = -0.74, p < 0.001; r = -0.70, p < 0.001). MOP had a high probability of adverse cardiovascular outcome (Log-rank test; p = 0.002). In univariate Cox analysis, mitral E/A ratio, BNP, and MO-TO time were significant predictors (p = 0.044, p = 0.019, and p = 0.012), respectively. An addition of MOP improved the predictive power of univariate predictors (mitral E/A ratio, BNP) in the bivariate Cox analysis. Conclusions: The MO-TO time may be a useful marker to detect the elevation of PAWP and mPAP. MOP reflects pulmonary hypertension due to left heart disease and has a prognostic value in predicting adverse cardiovascular events in patients with HF.