PURPOSE: Trace mitral regurgitation (MR) is often considered to be benign, and a reflection of improved diagnostic technology. However in hypertensive patients, this may not be true. This retrospective study was done to evaluate the role played by increased systemic vascular resistance (SVR) in the pathogenesis of trace MR in an hypertensive population.
METHODS: Non-invasive hemodynamic measurements and echocardiograms of 100 consecutive patients were retrospectively reviewed. SVR was measured using BioZ ICG Monitor (CardioDynamics). SVR was considered high if it was more than 1378 dynes × s/cm5. All echocardiographic examinations were performed with commercially available phased-array transducers, using frequencies between 2.5 and 3.5 MHz, and recorded on thermal paper and VHS videotapes. Patients with mitral valve disease, left ventricular dysfunction (ejection fraction <50%) or mitral regurgitation exceeding a trace amount, were excluded. MR was defined as a narrow jet arising at the coaptation point, and extending less than 1 cm from the leaflet.
RESULTS: Out of the 100 patients [54 (54.0%) males; 46 (46.0%) females], 59 (59.0%) had elevated SVR and 41 (41.0%) had normal SVR. Of the 59 with elevated SVR, 32 (54.2%) had trace MR and 27 (45.8%) did not. Of the 41 with normal SVR, 8 (19.5%) had trace MR and 33 (80.5%) did not. Of the total 100 patients, 40 (40.0%) had trace MR while 60 (60.0%) did not. Of these 40, 32 (80.0%) showed elevated SVR and 8 (20.0%) had normal SVR. Of the 60 without trace MR, 27 (45.0%) showed elevated SVR and 33 (55.0%) showed normal SVR.
CONCLUSION: Most hypertensive patients with a trace MR on the echocardiogram have an elevated SVR. Most hypertensive patients with a normal SVR do not show MR on their echocardiograms.
CLINICAL IMPLICATIONS: Trace MR may not be as benign as is usually thought of in a hypertensive population. It appears to be a marker for elevated SVR. These patients should benefit with an aggressive approach aimed at normalizing the SVR by further reductions in afterload.
DISCLOSURE: Shashi Agarwal, No Financial Disclosure Information; No Product/Research Disclosure Information