Peak vs mean trans-mitral gradient in mitral stenosis

Peak vs mean trans-mitral gradient in mitral stenosis

Peak trans-mitral gradient depends on the left atrial compliance and left ventricular diastolic function.
Mean trans-mitral gradient reflects the severity of mitral stenosis better than peak trans mitral gradient.
It should be remembered that trans-mitral gradient also depends on the heart rate and cardiac output. Gradient increases with increase in heart rate which shortens the diastolic period. Enhanced flow by increasing the cardiac output also increases the gradient across any valve.