Midazolam-induced underestimation of mitral regurgitation severity and its pharmacological reversal with…

StudyJournal of cardiovascular medicine (Hagerstown, Md.)· Jul 2026

Midazolam-induced underestimation of mitral regurgitation severity and its pharmacological reversal with flumazenil.

Hatice Tolunay, Özge Kurmus Ferik, Fatih Cihat Büyükbaş … Funda Basyigit

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Cardiac & Thoracic AnesthesiaStudyDiagnosisQ2IF 2.2

Midazolam sedation was associated with lower mitral regurgitation severity in most patients during transesophageal echocardiography

Midazolam-induced underestimation of mitral regurgitation severity and its pharmacological reversal with flumazenil.

Hatice Tolunay … Funda Basyigit

Journal of cardiovascular medicine (Hagerstown, Md.) · Jul 2026 · Q2 in General Medicine

Background

Sedative agents may alter hemodynamic status and influence the echocardiographic assessment of mitral regurgitation.

Methods

Seventy-four patients with moderate or greater mitral regurgitation (41 primary, 33 secondary) were included.

Results

midazolam sedation eased mitral regurgitation by half a grade in most patients

61% of p

Severity decreased pos

68% of p

Severity increased pos

More results

Midazolam significantly reduced heart rate and blood pressure in both groups.

More results

In patients with primary mitral regurgitation, baseline, postmidazolam, and postflumazenil measurements were as follows: effective regurgitant orifice area 0.31 ± 0.14, 0.25 ± 0.12, and 0.36 ± 0.14 cm2; regurgitant volume 46.71 ± 14.95, 40.76 ± 16.90, and 59.44 ± 18.11 mL; vena contracta width 5.30 ± 1.06, 4.86 ± 1.05, and 5.82 ± 1.16 mm (all P < 0.001).

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Conclusion · 1 of 2

Midazolam is associated with reduced echocardiographic mitral regurgitation severity during transesophageal echocardiography, likely through sedation-related changes in loading conditions, whereas flumazenil reverses these changes.

Conclusion · 2 of 2

Differences between baseline transthoracic echocardiography and postflumazenil transesophageal echocardiography measurements should be interpreted in light of both recovery from sedation and known modality-related differences between transthoracic echocardiography and transesophageal echocardiography.

Midazolam-induced underestimation of mitral regurgitation severity and its pharmacological reversal with flumazenil.

Midazolam-induced underestimation of mitral regurgitation severity and its pharmacological reversal with flumazenil.

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