Title: Mitral Leaflet Separation Index (MLSI): A step ahead to assess severity of mitral stenosis in patients with Atrial Fibrillation
Authors: Omkar Singh, Sangeeta Aneja, Mridul Chaturvedi, T P Singh
DOI: https://dx.doi.org/10.18535/jmscr/v7i1.188
Abstract
Background: Assessment of severity of mitral stenosis by using planimetry and pressure half time method has been difficult and inaccurate at times and therefore an alternate method mitral leaflet separation index (MLSI) was advised. We correlated the severity of mitral stenosis by this method with mitral valve area by using planimetry and pressure half time.
Methods: The study was a hospital based prospective study and was done in S.N Medical College Agra between March 2013 and August 2014. Study included the patients who were having mitral stenosis, already diagnosed and those who were diagnosed for the first time in our department. Severity of mitral stenosis was assessed using Planimetry and Pressure Half Time. MLSI was measured by measuring maximal separation between inner edges of leaflets on parasternal long axis view and apical 4 chamber view and average of the two was taken.
Results: MLSI correlates very well with both planimetry (r = 0.962) and pressure half time method (r = 0.955). The value of correlation coefficient by both methods is very near to 1 and hence shows that there is very high degree of correlation between both the variables. While assessing the severity of mitral stenosis in patients with atrial fibrillation MLSI correlates very well MVA by planimetry (r = 0.895) and MVA by pressure half time (r = 0.836), however correlation with MVA by planimetry is much higher than MVA by pressure half time method
Conclusions: Specially in patients with Atrial fibrillation where pressure half time method is not reliable and planimetry is not able to assess the area accurately due to calcification of leaflets leading to irregular margins or poor echo window on parasternal short axis view in some cases like obese, emphysematous chest or females, Mitral leaflet separation index can be used as reliable method to assess the severity.
Keywords: mitral leaflet separation index; mitral stenosis; planimetry; atrial fibrillation; pressure half time.
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