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Kikuchi Y, Onohara D, Silverman M, King CL, Tom SK, Govin R, Guyton RA, Padala M. Mitral regurgitation increases systolic strains in remote zone and worsens left ventricular dyssynchrony in a swine model of ischemic cardiomyopathy. Front Cardiovasc Med 2024; 11:1397079. [PMID: 38863901 PMCID: PMC11165204 DOI: 10.3389/fcvm.2024.1397079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/14/2024] [Indexed: 06/13/2024] Open
Abstract
Background Ischemic mitral regurgitation (IMR) imposes volume overload on the left ventricle (LV), accelerating adverse LV remodeling. In this study, we sought to investigate the impact of volume overload due to IMR on regional myocardial contractile mechanics. Methods Ten Yorkshire swine were induced with myocardial infarction (MI) by occluding the left circumflex coronary artery (LCx). Cardiac MRI was performed at baseline (BL) and 2.5 months (2.5M) post-MI. IMR was quantified with epicardial echocardiography 3 months post-MI. The animals were then assigned to 2 groups: no/mild MR (nmMR, n = 4) and moderate/severe MR (msMR, n = 6). MRI images were analyzed to assess infarction size, end-diastolic and end-systolic volume (EDV and ESV, respectively), ejection fraction (EF), longitudinal strain (LS), circumferential strain (CS), and systolic dyssynchrony index (SDI). The myocardial region was divided into infarction, border, and remote zones based on the LCx-supplied region. Results There was no difference in the infarction size. Group-wise comparison of LS and CS between BL and 2.5M demonstrated that LS and CS in the infarction zone and the border zone decreased at 2.5M in both groups. However, LS and CS in the remote zone were elevated only in the msMR group (LS: -9.81 ± 3.96 vs. -12.58 ± 5.07, p < 0.01; CS; -12.78 ± 3.81 vs. -16.09 ± 3.33, p < 0.01) at 2.5M compared to BL. The SDI of CS was significantly elevated in the msMR group (0.1255 vs. 0.0974, p = 0.015) at 2.5M compared to BL. Conclusions Elevated LS and CS in the remote zone were observed in moderate/severe MR and ventricular dyssynchrony. These elevated cardiac strains, coupled with ventricular dyssynchrony, may contribute to the progression of MR, thereby accelerating heart failure.
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Affiliation(s)
- Yuta Kikuchi
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
| | - Daisuke Onohara
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
| | - Michael Silverman
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta GA, United States
| | - Chase L. King
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta GA, United States
| | - Stephanie K. Tom
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
- Department of Surgery, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta GA, United States
| | - Riya Govin
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Robert A. Guyton
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
| | - Muralidhar Padala
- Cardiothoracic Research Laboratories, Carlyle Fraser Heart Center at Emory University Hospital Midtown, Atlanta, GA, United States
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Stanley A, Athanasuleas C. Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity. Curr Cardiol Rev 2024; 20:93-101. [PMID: 38351687 PMCID: PMC11107465 DOI: 10.2174/011573403x277223240206062319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 04/30/2024] Open
Abstract
Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle's initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction. Early serial measurements of left ventricular sphericity index [LV-Si]. during the compensated stage of mitral regurgitation might identify subtle changes in left ventricular shape and assist in determining the optimal earliest timing for surgical intervention.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham, AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, North Alabama Medical Center and Kemp-Carraway Heart Institute, Birmingham, AL, USA
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3
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Kusunose K. Echocardiographic Phenotyping of Mitral Regurgitation for Clinical Decision Making. JACC Cardiovasc Imaging 2023; 16:1268-1270. [PMID: 37178076 DOI: 10.1016/j.jcmg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/02/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan.
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Carpenito M, Gelfusa M, Mega S, Cammalleri V, Benfari G, De Stefano D, Ussia GP, Tribouilloy C, Enriquez-Sarano M, Grigioni F. Watchful surgery in asymptomatic mitral valve prolapse. Front Cardiovasc Med 2023; 10:1134828. [PMID: 37123469 PMCID: PMC10130568 DOI: 10.3389/fcvm.2023.1134828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
The most common organic etiology of mitral regurgitation is degenerative and consists of mitral valve prolapse (MVP). Volume overload because of mitral regurgitation is the most common complication of MVP. Advocating surgery before the consequences of volume overload become irreparable restores life expectancy, but carries a risk of mortality in patients who are often asymptomatic. On the other hand, the post-surgical outcome of symptomatic patients is dismal and life expectancy is impaired. In the present article, we aim to bridge the gap between these two therapeutic approaches, unifying the concepts of watchful waiting and early surgery in a "watchful surgery approach".
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Affiliation(s)
- Myriam Carpenito
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Martina Gelfusa
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Simona Mega
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico De Stefano
- Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Correspondence: Francesco Grigioni
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5
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Tang SS, Shi R, Zhang Y, Li Y, Li XM, Yan WF, Jiang L, Yang ZG. Additive effects of mitral regurgitation on left ventricular strain in essential hypertensive patients as evaluated by cardiac magnetic resonance feature tracking. Front Cardiovasc Med 2022; 9:995366. [DOI: 10.3389/fcvm.2022.995366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectivesHypertension is one of the leading risk factors for cardiovascular disease. Mitral regurgitation (MR) is a heart valve disease commonly seen in hypertensive cases. This study aims to assess the effect of MR on left ventricle (LV) strain impairment among essential hypertensive cases and determine factors that independently impact the global peak strain of the LV.Materials and methodsWe enrolled 184 essential hypertensive patients, of which 53 were patients with MR [HTN (MR +) group] and 131 were without MR [HTN (MR−) group]. Another group of 61 age-and gender-matched controls was also included in the study. All participants had received cardiac magnetic resonance examination. The HTN (MR +) group was classified into three subsets based on regurgitation fraction, comprising mild MR (n = 22), moderate MR (n = 19), and severe MR (n = 12). We compared the LV function and strain parameters across different groups. Moreover, we performed multivariate linear regression to determine the independent factors affecting LV global radial peak strain (GRS), circumferential peak strain (GCS), and global longitudinal peak strain (GLS).ResultsHTN (MR−) cases exhibited markedly impaired GLS and peak diastolic strain rate (PDSR) but preserved LV ejection fraction (LVEF) compared to the controls. However, HTN (MR +) patients showed a decrease in LVEF and further deteriorated GRS, GCS, GLS, PDSR, and the peak systolic strain rate (PSSR) compared to the HTN (MR−) group and controls. With increasing degrees of regurgitation, the LV strain parameters were gradually reduced in HTN (MR +) patients. Even the mild MR group showed impaired GCS, GLS, PDSR, and PSSR compared to the HTN (MR−) group. Multiple regression analyses indicated that the degree of regurgitation was independently associated with GRS (β = -0.348), GCS (β = -0.339), and GLS (β = -0.344) in HTN (MR +) patients.ConclusionGLS was significantly impaired in HTN (MR−) patients. MR may further exacerbate the deterioration of LV strain among essential hypertensive cases. Besides, the degree of regurgitation was independently correlated with GRS, GCS, and GLS in HTN (MR +) patients.
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Trasca L, Popescu MR, Popescu AC, Balanescu SM. Echocardiography in the Diagnosis of Cardiomyopathies: Current Status and Future Directions. Rev Cardiovasc Med 2022; 23:280. [PMID: 39076629 PMCID: PMC11266959 DOI: 10.31083/j.rcm2308280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/07/2022] [Accepted: 06/27/2022] [Indexed: 07/31/2024] Open
Abstract
Cardiomyopathies are a challenging pathology and echocardiography is essential for diagnosis and prognosis. The most frequent cardiomyopathies are the dilated cardiomyopathy (DCM) and the hypertrophic cardiomyopathy (HCM), followed by the less frequent restrictive (RCM) and arrhythmogenic right ventricle cardiomyopathies (ARVC). Echocardiography can identify diagnostic features, and guide further testing for a definitive diagnosis. Echographic parameters are involved in risk score computing and prognosis assessment. While the most prevalent hallmark of HCM is the asymmetric left ventricular hypertrophy and systolic anterior motion of the mitral valve with the obstructive phenotype, DCM shows dilated left ventricle with different degrees of systolic dysfunction, and RCM is usually characterized by undilated ventricles associated with atrial enlargement. The aim of this review is to display and compare the most frequent cardiomyopathies encountered in clinical practice and highlight their most characteristic features in a useful way for the practicing clinician.
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Affiliation(s)
- Livia Trasca
- Cardiothoracic Medicine Department, “Carol Davila'' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 11461 Bucharest, Romania
| | - Mihaela Roxana Popescu
- Cardiothoracic Medicine Department, “Carol Davila'' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 11461 Bucharest, Romania
| | - Andreea Catarina Popescu
- Cardiothoracic Medicine Department, “Carol Davila'' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 11461 Bucharest, Romania
| | - Serban Mihai Balanescu
- Cardiothoracic Medicine Department, “Carol Davila'' University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 11461 Bucharest, Romania
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7
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Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease. Int J Cardiovasc Imaging 2022; 38:2667-2676. [DOI: 10.1007/s10554-022-02678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
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8
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Nicolosi GL. Why are left ventricular linear internal diameters still so important for clinical decision-making to undergo surgery in asymptomatic patients with chronic severe aortic or primary mitral regurgitation? J Cardiovasc Med (Hagerstown) 2022; 23:304-307. [PMID: 35486681 DOI: 10.2459/jcm.0000000000001298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gian Luigi Nicolosi
- Division of Cardiology, A.R.C., Policlinico San Giorgio, Via Gemelli 10, Pordenone, Italy
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9
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Verbeke J, Calle S, Kamoen V, De Buyzere M, Timmermans F. Prognostic value of myocardial work and global longitudinal strain in patients with heart failure and functional mitral regurgitation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:803-812. [PMID: 34802090 DOI: 10.1007/s10554-021-02474-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
In patients with heart failure and functional mitral regurgitation (FMR), the assessment of left ventricular (LV) function is important for risk stratification and decision making. As LV ejection fraction (LVEF) might not be an optimal metric for LV systolic performance in this population, alternatives such as global longitudinal strain (GLS) and global myocardial work index (GWI) have been proposed. In the present study, we investigated the prognostic value of GLS and GWI and compared these measures to other LV systolic performance parameters. A prospective and consecutive cohort of 181 patients (median age 72 years, 76% male) with LVEF < 50% and FMR underwent comprehensive echocardiographic examination including speckle tracking echocardiography and grading of FMR severity. During a median follow-up of 42 months, 72 cardiovascular (CV) events occurred. In univariate analysis, LVEF, GLS, GWI, mitral S', LV outflow tract time velocity integral, forward LVEF and LV ejection time were associated with CV events. After multivariate adjustment only GLS (hazard ratio (HR) = 0.884, p = 0.015) and GWI (HR = 0.927, p = 0.034) remained independently associated with CV events. There was no difference in the incremental prognostic value of GWI compared to GLS (delta -2 log likelihood = 0.8; p = 0.37). In this cohort of heart failure patients with FMR, GLS and GWI were independently associated with cardiovascular events, whereas other systolic performance parameters were not. However, GWI did not outperform GLS, and further research is required to determine the value of these strain-based measures in clinical practice.
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Affiliation(s)
- Jonas Verbeke
- Department of Cardiology, Ghent University Hospital, Ghent University, 10-K12; C. Heymanslaan, 10, 9000, Ghent, Belgium.
| | - Simon Calle
- Department of Cardiology, Ghent University Hospital, Ghent University, 10-K12; C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Victor Kamoen
- Department of Cardiology, Ghent University Hospital, Ghent University, 10-K12; C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Marc De Buyzere
- Department of Cardiology, Ghent University Hospital, Ghent University, 10-K12; C. Heymanslaan, 10, 9000, Ghent, Belgium
| | - Frank Timmermans
- Department of Cardiology, Ghent University Hospital, Ghent University, 10-K12; C. Heymanslaan, 10, 9000, Ghent, Belgium
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10
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Wang TKM, Akyuz K, Reyaldeen R, Griffin BP, Popovic ZB, Pettersson GB, Gillinov AM, Flamm SD, Xu B, Desai MY. Prognostic Value of Complementary Echocardiography and Magnetic Resonance Imaging Quantitative Evaluation for Isolated Tricuspid Regurgitation. Circ Cardiovasc Imaging 2021; 14:e012211. [PMID: 34521215 DOI: 10.1161/circimaging.120.012211] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Isolated tricuspid regurgitation (TR) remains a management dilemma with poor outcomes. Echocardiography and cardiac magnetic resonance imaging (CMR) are valuable tools for evaluating TR, but their prognostic utility has rarely been studied together in this setting. We aimed to determine the prognostic value and thresholds for echocardiography and CMR parameters for isolated severe TR. METHODS Consecutive patients with isolated severe TR by echocardiography and undergoing CMR during January 2007 to June 2019 were studied. Echocardiography and CMR-derived quantitative parameters were analyzed for independent associations with and thresholds for predicting the primary end point of all-cause mortality during follow-up. RESULTS Among 262 patients studied, mean age was 62.8±15.6 years, 156 (59.5%) were females, 207 (79.0%) had secondary TR, and 87 (33.2%) underwent tricuspid valve surgery after CMR. There were 68 (26.0%) deaths during a mean follow-up of 2.5 years. Both CMR-derived tricuspid regurgitant fraction (per 5% increase) and right ventricle free wall longitudinal strain (per 1% decrease in magnitude) were independently associated with worse survival, with hazard ratios (95% CIs) of 1.15 (1.05-1.25) and 1.10 (1.04-1.17), respectively, along with right heart failure symptoms of 2.03 (1.14-3.60), while tricuspid valve surgery was borderline protective with 0.55 (0.31-0.997). Regurgitant fraction ≥30%, regurgitant volume ≥35 mL and right ventricle free wall longitudinal strain ≥-11% (by velocity vector imaging technique, which yields lower magnitude values than other conventional strain techniques) were the optimal thresholds for mortality during follow-up. CONCLUSIONS TR quantification by CMR and right ventricle free wall longitudinal strain by echocardiography were the key imaging parameters independently associated with reduced survival in isolated TR, incremental to conventional clinical factors. Clinically significant thresholds for these parameters were determined and may help guide decision-making for TR management.
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Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Kevser Akyuz
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Reza Reyaldeen
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popovic
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery (G.B.P., A.M.G.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery (G.B.P., A.M.G.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Scott D Flamm
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bo Xu
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Section of Cardiovascular Imaging (T.K.M.W., K.A., R.R., B.P.G., Z.B.P., S.D.F., B.X., M.Y.D.), Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
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11
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Modaragamage Dona AC, Afoke J, Punjabi PP, Kanaganayagam GS. Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review. J Card Surg 2021; 36:2458-2466. [PMID: 33783012 DOI: 10.1111/jocs.15521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients. METHODS Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery. Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed. RESULTS Baseline GLS is an independent predictor of postoperative outcomes, ranging from -17.9 to -21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery. CONCLUSION GLS shows sensitivity in predicting long-term postoperative outcomes. Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.
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Affiliation(s)
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gajen S Kanaganayagam
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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12
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Misfeld M, Borger MA. Commentary: More insights into the resect versus respect debate: Will we ever have a winner? J Thorac Cardiovasc Surg 2021; 164:1500-1501. [PMID: 33867125 DOI: 10.1016/j.jtcvs.2021.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Martin Misfeld
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael A Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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Lakatos BK, Ruppert M, Tokodi M, Oláh A, Braun S, Karime C, Ladányi Z, Sayour AA, Barta BA, Merkely B, Radovits T, Kovács A. Myocardial work index: a marker of left ventricular contractility in pressure- or volume overload-induced heart failure. ESC Heart Fail 2021; 8:2220-2231. [PMID: 33754487 PMCID: PMC8120402 DOI: 10.1002/ehf2.13314] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/15/2021] [Accepted: 03/02/2021] [Indexed: 12/11/2022] Open
Abstract
Aims While global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function, it is significantly influenced by loading conditions. We hypothesized that global myocardial work index (GMWI), a novel marker of LV function, may show better correlation with load‐independent markers of LV contractility in rat models of pressure‐induced or volume overload‐induced heart failure. Methods and results Male Wistar rats underwent either transverse aortic constriction (TAC; n = 12) or aortocaval fistula creation (ACF; n = 12), inducing LV pressure or volume overload, respectively. Sham procedures were performed to establish control groups (n = 12/12). Echocardiographic loops were obtained to determine GLS and GMWI. Pressure‐volume analysis with transient occlusion of the inferior caval vein was carried out to calculate preload recruitable stroke work (PRSW), a load‐independent ‘gold‐standard’ parameter of LV contractility. Myocardial samples were collected to assess interstitial and perivascular fibrosis area and also myocardial atrial‐type natriuretic peptide (ANP) and brain‐type natriuretic peptide (BNP) relative mRNA expression. Compared with controls, GLS was substantially lower in the TAC group (−7.0 ± 2.8 vs. −14.5 ± 2.5%; P < 0.001) and was only mildly reduced in the ACF group (−13.2 ± 2.4 vs. −15.4 ± 2.0%, P < 0.05). In contrast with these findings, PRSW and GMWI were comparable with sham in TAC (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 mmHg% vs. 1537 ± 662 mmHg%; both P = NS), while it was found to be significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both P < 0.01). In the pooled population, GMWI (r = 0.70; P < 0.001) but not GLS (r = −0.23; P = 0.12) showed a strong correlation with PRSW. GLS correlated with interstitial (r = 0.61; P < 0.001) and perivascular fibrosis area (r = 0.54; P < 0.001), and also with myocardial ANP (r = 0.85; P < 0.001) and BNP relative mRNA expression (r = 0.75; P < 0.001), while GMWI demonstrated no or only marginal correlation with these parameters. Conclusions Being significantly influenced by loading conditions, GLS may not be a reliable marker of LV contractility in heart failure induced by pressure or volume overload. GMWI better reflects contractility in haemodynamic overload states, making it a more robust marker of systolic function, while GLS should be considered as an integrative marker, incorporating systolic function, haemodynamic loading state, and adverse tissue remodelling of the LV.
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Affiliation(s)
- Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Mihály Ruppert
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Szilveszter Braun
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Christian Karime
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Alex Ali Sayour
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Bálint András Barta
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Tamás Radovits
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Városmajor St. 68, Budapest, H-1122, Hungary
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The mitral regurgitation effects of cardiac structure and function in left ventricular noncompaction. Sci Rep 2021; 11:4616. [PMID: 33633309 PMCID: PMC7907249 DOI: 10.1038/s41598-021-84233-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/11/2021] [Indexed: 02/05/2023] Open
Abstract
This study evaluated the effects of mitral regurgitation (MR) on cardiac structure and function in left ventricular noncompaction (LVNC) patients. The clinical and cardiovascular magnetic resonance (CMR) data for 182 patients with noncompaction or hypertrabeculation from three institutes were retrospectively included. We analyzed the difference in left ventricular geometry, cardiac function between LVNC patients with and without MR. The results showed that patients with MR had a worse New York Heart Association (NYHA) class and a higher incidence of arrhythmia (P < 0.05). MR occurred in 48.2% of LVNC patients. Compared to LVNC patients without MR, the two-dimensional sphericity index, maximum/minimum end-diastolic ratio and longitudinal shortening in LVNC patients with MR were lower (P < 0.05), and the peak longitudinal strain (PLS) of the global and segmental myocardium were obviously reduced (P < 0.05). No significant difference was found in strain in LVNC patients with different degree of MR; end diastolic volume, end systolic volume, and global PLS were statistically associated with MR and NYHA class (P < 0.05), but the non-compacted to compacted myocardium ratio had no significant correlation with them. In conclusion, the presence of MR is common in LVNC patients. LVNC patients with MR feature more severe morphological and functional changes. Hypertrabeculation is not an important factor affecting structure and function at the heart failure stage.
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15
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Watt TMF, Duggal NM, Ailawadi G. Commentary: A Strained or Depressed Heart: When Should Mitral Regurgitation Be Addressed? Semin Thorac Cardiovasc Surg 2020; 33:345-346. [PMID: 33181294 DOI: 10.1053/j.semtcvs.2020.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Tessa M F Watt
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Neal M Duggal
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Michigan.
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16
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Canessa M, Thamman R, Americo C, Soca G, Dayan V. Global Longitudinal Strain Predicts Survival and Left Ventricular Function After Mitral Valve Surgery: A Meta-analysis. Semin Thorac Cardiovasc Surg 2020; 33:337-342. [PMID: 32971244 DOI: 10.1053/j.semtcvs.2020.09.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023]
Abstract
The timing for surgical treatment in patients with primary organic severe mitral valve regurgitation and preserved left ventricular ejection fraction (LVEF) systolic is a challenge since it depends upon LV end systolic dimension and LVEF which may be late markers of LV dysfunction. Echocardiography is the most important tool in the diagnosis of mechanisms, etiology, severity, and hemodynamic consequences of mitral regurgitation. The global longitudinal strain (GLS), a new and sensitive method for the detection of LV dysfunction, might be a useful method for the evaluation of preclinical systolic dysfunction. Nevertheless, its role for predicting postoperative outcomes is not well established. A meta-analysis was performed to address the role of GLS in patients with severe mitral regurgitation and preserved LVEF who underwent mitral surgery. We included studies that compared outcomes according to preoperative GLS in regard to survival and postoperative LV function. We included 2358 patients enrolled in 8 studies. Patients with reduced GLS% had worse long term survival after mitral valve surgery (hazard ratio = 1.13, 95% confidence interval [CI]: 1.02-1.26). Patients with preoperatively reduced GLS% had lower LVEF after surgery (mean difference [MD] = -5.06%, 95% CI: -8.97-1.16%) and additionally, patients who presented postoperative LVEF dysfunction had worse preoperative GLS (MD = 4.33, 95% CI: 3.89-4.76). In patients with primary mitral regurgitation, preoperative GLS is a predictor for long term survival and postoperative LVEF. It is a useful parameter to be included when considering early surgery in patients with severe mitral regurgitation and normal LVEF.
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Affiliation(s)
- Martin Canessa
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Ritu Thamman
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carlos Americo
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Gerardo Soca
- National Institute of Cardiac Surgery, Montevideo, Uruguay
| | - Victor Dayan
- National Institute of Cardiac Surgery, Montevideo, Uruguay; Centro Cardiovascular Universitario, Montevideo, Uruguay.
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