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Dirsienė R, Martinaitytė R, Tamulėnaitė E, Montvilaitė A, Karčiauskas D, Ereminienė E, Vaškelytė JJ. Left atrium volume and function changes during stress in patients with primary mitral regurgitation and preserved left ventricular ejection fraction. Perfusion 2024:2676591241251441. [PMID: 38687977 DOI: 10.1177/02676591241251441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
INTRODUCTION Patients with primary mitral regurgitation (MR) usually remain asymptomatic for a long time due to compensatory mechanisms and an adequate treatment could be delayed. Stress echocardiography and speckle-tracking analysis could help to evaluate impaired left atrium (LA) function before the manifestation of clinically significant myocardial changes in asymptomatic patients with primary MR and preserved left ventricular (LV) ejection fraction (EF). METHODS This study prospectively enrolled 91 patients with preserved LV EF (≥60%) at rest, of which 60 patients had moderate-to-severe MR and 31 were healthy controls. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. RESULTS In MR group LA volume indices were higher at rest and during stress, while LA reservoir, conduit, and contractile fractions were decreased (p < .005). LA deformation parameters at rest were similar in both groups. During maximum stress LA conduit, contractile fractions and reservoir strain were lower (p < .05) in patients with MR. Indices of LA volume were related to SPAP at rest and during stress. Higher NT-proBNP concentrations was associated with higher LA volume indices, decreased contractile and reservoir functions during peak stress (p < .05). LA volume indices, LA EF, and filling index at rest could predict exercise-induced pulmonary hypertension (EIPH) (p < .05). CONCLUSIONS In patients with primary MR and preserved LV EF, LA parameters are related to SPAP and NT-pro-BNP concentration. LA volume indices, LA EF and LA filling index are predictors of EIPH.
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Affiliation(s)
- Rūta Dirsienė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rugilė Martinaitytė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Tamulėnaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aistė Montvilaitė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius Karčiauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Justina Jolanta Vaškelytė
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Tomaselli M, Badano LP, Oliverio G, Curti E, Pece C, Springhetti P, Milazzo S, Clement A, Penso M, Gavazzoni M, Hădăreanu DR, Mihaila SB, Pugliesi GM, Delcea C, Muraru D. Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2024; 37:408-419. [PMID: 38244817 DOI: 10.1016/j.echo.2024.01.004] [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: 09/20/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients. METHODS We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause. RESULTS After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; P = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; P = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM (P < .05 for all). Kaplan-Meier analysis demonstrated a significantly higher rate of events in patients with EROA ≥ 0.3 cm2 (cumulative survival at 2 years: 28% ± 7% vs 32% ± 10% vs 30% ± 11%) and RegVol ≥ 45 mL (cumulative survival at 2 years: 21% ± 7% vs 24% ± 13% vs 22% ± 10%) by 3DEVM compared to those by PISA and 2DEVM, respectively. In Cox multivariable analysis, 3DEVM EROA remained independently associated with the end point (hazard ratio, 1.02, 95% CI, 1.00-1.05; P = .02). The model including EROA by 3DEVM provided significant incremental value to predict the combined end point compared to those using 2DEVM (net reclassification index = 0.51, P = .003; integrated discrimination index = 0.04, P = .014) and PISA (net reclassification index = 0.80, P < .001; integrated discrimination index = 0.06, P < .001). CONCLUSIONS Effective regurgitant orifice area and RegVol calculated by 3DEVM were independently associated with the end point, improving the risk stratification of patients with v-SMR compared to the 2DEVM and PISA methods.
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Affiliation(s)
- Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Luigi P Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
| | - Giorgio Oliverio
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Emanuele Curti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cinzia Pece
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Paolo Springhetti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Salvatore Milazzo
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Alexandra Clement
- Internal Medicine Department, "Grigore T. Popa", University of Medicine and Pharmacy, Iasi, Romania
| | - Marco Penso
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Diana R Hădăreanu
- Department of Cardiology, Clinical Emergency County Hospital of Craiova, Craiova, Romania
| | - Sorina Baldea Mihaila
- Cardiology Department, Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Giordano M Pugliesi
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Caterina Delcea
- Cardiology Department, Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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3
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Pino PG, Madeo A, Lucà F, Ceravolo R, di Fusco SA, Benedetto FA, Bisignani G, Oliva F, Colivicchi F, Gulizia MM, Gelsomino S. Clinical Utility of Three-Dimensional Echocardiography in the Evaluation of Mitral Valve Disease: Tips and Tricks. J Clin Med 2023; 12:jcm12072522. [PMID: 37048605 PMCID: PMC10094963 DOI: 10.3390/jcm12072522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.
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Affiliation(s)
- Paolo G. Pino
- Former Cardiology Department, San Camillo Forlanini Hospital, 00151 Roma, Italy
| | - Andrea Madeo
- Cardiology Department, Ferrari Hospital, 87012 Castrovillari, Italy
| | - Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | - Roberto Ceravolo
- Cardiology Unit, Giovanni Paolo II Hospital, 88046 Lamezia, Italy
| | | | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano, GOM, AO Bianchi Melacrino Morelli, 89129 Reggio Calabria, Italy
| | | | - Fabrizio Oliva
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
| | - Furio Colivicchi
- Cardiology Department, San Filippo Neri Hospital, 00135 Rome, Italy
| | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, 6211 LK Maastrich, The Netherlands
- Correspondence:
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4
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Harada Y, Utsunomiya H, Susawa H, Takahari K, Takemoto H, Ueda Y, Izumi K, Itakura K, Hidaka T, Nakano Y. Determinants of Exercise-Induced Mitral Regurgitation Using Three-Dimensional Transesophageal Echocardiography Combined With Isometric Handgrip Exercise. Am J Cardiol 2021; 151:78-85. [PMID: 34049673 DOI: 10.1016/j.amjcard.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022]
Abstract
Using three-dimensional (3D) transesophageal echocardiography (TEE) and isometric handgrip exercise (IHE), we investigated the determinants of exercise-induced mitral regurgitation (MR) according to MR etiologies. Seventy-six patients with more than moderate MR, 40 patients with functional MR (FMR) and 36 patients with degenerative MR (DMR), underwent 3D TEE combined with IHE. Mitral valve (MV) geometry and 3D vena contracta area (3D VCA) were simultaneously evaluated at baseline and during IHE. With regard to exercise-induced MR, Δ3D VCA was calculated as the difference between 3D VCA at baseline and 3D VCA during IHE. IHE caused different changes in MV geometry between etiologies and led to exacerbation of 3D VCA at baseline. Larger Δ3D VCA was observed in the FMR group compared with the DMR group (15.9 ± 10.3 mm2 versus 7.3 ± 4.2 mm2; p < 0.0001). In multivariate analyses, tenting height and 3D VCA were selected as independent factors associated with Δ3D VCA in the FMR group (p = 0.0135 and p = 0.0201, respectively), while flail width was selected as an independent factor associated with Δ3D VCA in the DMR group (p = 0.0066). In conclusion, IHE alters mitral valve geometry and causes exacerbation of MR regardless of MR etiology and the determinants of exercise-induced MR differed between MR etiologies.
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Affiliation(s)
- Yu Harada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Hitoshi Susawa
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hajime Takemoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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5
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Hedwig F, Nemchyna O, Stein J, Knosalla C, Merke N, Knebel F, Hagendorff A, Schoenrath F, Falk V, Knierim J. Myocardial Work Assessment for the Prediction of Prognosis in Advanced Heart Failure. Front Cardiovasc Med 2021; 8:691611. [PMID: 34222382 PMCID: PMC8249920 DOI: 10.3389/fcvm.2021.691611] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in advanced heart failure. Background: Global work index (GWI) and global constructive work (GCW) are calculated by means of speckle tracking, blood pressure measurement, and a normalized reference curve. Their prognostic value in advanced heart failure is unknown. Methods: Cardiopulmonary exercise testing and echocardiography with assessment of GWI and GCW was performed in patients with advanced heart failure caused by ischemic heart disease or dilated cardiomyopathy (n = 105). They were then followed up repeatedly. The combined endpoint was all-cause death, implantation of a left ventricular assist device, or heart transplantation. Results: The median patient age was 54 years (interquartile range [IQR]: 48–59.9). The mean left ventricular ejection fraction was 27.8 ± 8.2%, the median NT-proBNP was 1,210 pg/ml (IQR: 435–3,696). The mean GWI was 603 ± 329 mmHg% and the mean GCW was 742 ± 363 mmHg%. The correlation between peak oxygen uptake and GWI as well as GCW was strongest in patients with ischemic cardiomyopathy (r = 0.56, p = 0.001 and r = 0.53, p = 0.001, respectively). The median follow-up was 16 months (IQR: 12–18.5). Thirty one patients met the combined endpoint: Four patients died, eight underwent transplantation, and 19 underwent implantation of a left ventricular assist device. In the multivariate Cox regression analysis, only NYHA class, NT-proBNP and GWI (hazard ratio [HR] for every 50 mmHg%: 0.85; 95% CI: 0.77–0.94; p = 0.002) as well as GCW (HR for every 50 mmHg%: 0.86; 95% CI: 0.79–0.94; p = 0.001) were identified as independent predictors of the endpoint. The cut-off value for predicting the outcome was 455 mmHg% for GWI (AUC: 0.80; p < 0.0001; sensitivity 77.4%; specificity 71.6%) and 530 mmHg% for GCW (AUC: 0.80; p < 0.0001; sensitivity 74.2%; specificity 78.4%). Conclusions: GWI and GCW are powerful predictors of outcome in patients with advanced heart failure.
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Affiliation(s)
- Felix Hedwig
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | | | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Leipzig, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Eidgenössische Technische Hochschule Zürich, Department of Health Sciences and Technology, Translational Cardiovascular Technology, Zurich, Switzerland
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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6
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Ozel R, Ozer PK, Serbest NG, Atıcı A, Onur I, Bugra Z. Prior angina reduces ıschemic mitral regurgitation in patients with ST-Elevation myocardial ınfarction, role of ıschemic preconditioning. Int J Cardiovasc Imaging 2021; 37:2465-2472. [PMID: 33813680 DOI: 10.1007/s10554-021-02229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
Mitral regurgitation may develop due to left ventricular (LV) remodeling within 3 months following acute myocardial infarction (AMI) and is called ischemic mitral regurgitation (IMR). Ischemic preconditioning (IPC) has been reported as the most important mechanism of the association between prior angina and the favorable outcome. The aim of this study was to investigate the effect of prior angina on the development and severity of IMR at 3rd month in patients with ST elevation MI (STEMI). Fourty five (45) patients admitted with STEMI and at least mild IMR, revascularized by PCI were enrolled. According to presence of prior angina within 72 h before STEMI, patients were then divided into two groups as angina (+) (n:26; 58%) and angina (-) (n:19; 42%). All patients underwent 2D transthoracic echocardiography at 1st, 3rd days and 3rd month. IMR was evaluated by proximal isovelocity surface area (PISA) method: PISA radius (PISA-r), effective regurgitant orifice area (EROA), regurgitant volume (Rvol). LV ejection fraction (EF %) was calculated by Simpson's method. High sensitive troponin T (hs-TnT), creatine phosphokinase myocardial band (CK-MB) and N-terminal pro-brain natriuretic peptid (NTpro-BNP) levels were compared between two groups. Although PISA-r, EROA and Rvol were similar in both groups at 1st and 3rd days, all were significantly decreased (p = 0.012, p = 0.007, p = 0.011, respectively) and EF was significantly increased (p< 0 .001) in angina (+) group at 3rd month. NTpro-BNP and hs-TnT levels at 1st day and 3rd month were similar, however CK-MB level at 3rd month was found to be significantly lower in the angina (+) group (p = 0.034). At the end of the 3rd month, it was observed that the severity of IMR evaluated by PISA method was decreased and EF increased significantly in patients who defined angina within 72 h prior to STEMI, suggesting a relation with IPC.
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Affiliation(s)
- Ramime Ozel
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey.
| | - Nail Guven Serbest
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Adem Atıcı
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Imran Onur
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
| | - Zehra Bugra
- Department of Cardiology, Istanbul Medical Faculty, Istanbul University, Topkapi Mahallesi, Turgut Ozal Millet Caddesi, 34093, Fatih/Istanbul, Turkey
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7
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Dynamic Systolic Changes in Tricuspid Regurgitation Vena Contracta Size and Proximal Isovelocity Surface Area in Hypoplastic Left Heart Syndrome: A Three-Dimensional Color Doppler Echocardiographic Study. J Am Soc Echocardiogr 2021; 34:877-886. [PMID: 33753189 DOI: 10.1016/j.echo.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/24/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aims of this study were to investigate the dynamic changes in the vena contracta (VC) and proximal isovelocity surface area (PISA) through systole in patients with hypoplastic left heart syndrome and tricuspid regurgitation and to identify the stage of systole (early, mid, or late) in which VC and PISA radius are optimal. METHODS Twenty-eight patients with hypoplastic left heart syndrome were prospectively studied using continuous two-dimensional (2D) and three-dimensional (3D) echocardiography. Two-dimensional VC width, 3D VC area, and PISA radii (2D and 3D) were measured frame by frame throughout systole. The maximal 2D VC width, 3D VC area, and PISA radii in the first, middle, and last thirds of systole were compared, and correlations were explored with 3D tricuspid annular areas, right atrial volumes, and right ventricular volumes. RESULTS In all, 35 data sets that met inclusion criteria were analyzed. On frame-by-frame analysis, maximal 2D VC width and 3D VC area were found in the first third of systole in 17% and 20% of studies, in the second third in 34% and 31%, and in the final third in 49% and 49%. Similarly, the maximal 2D and 3D PISA radii were found in the first third of systole in 26% and 17% of studies, in the second third in 28% and 34%, and in the final third in 46% and 49%. CONCLUSIONS In hypoplastic left heart syndrome, detailed temporal analysis of tricuspid regurgitation-associated VC and PISA by 2D and 3D echocardiography reveals no reliable pattern predicting when in systole these parameters peak. Frame-by-frame measurement is necessary for identification of maximal VC and PISA radius on 2D and 3D color Doppler echocardiography because the severity of tricuspid regurgitation could be underestimated because of temporal variability in VC and PISA.
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8
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Žvirblytė R, Montvilaitė A, Tamulėnaitė E, Saniukaitė A, Ereminienė E, Vaškelytė JJ. Echocardiographic predictors of exercise induced pulmonary hypertension in patients with asymptomatic moderate to severe mitral regurgitation and preserved left ventricular ejection fraction. Perfusion 2021; 37:188-197. [PMID: 33509060 DOI: 10.1177/0267659120987545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significant role of mitral regurgitation (MR) in development of pulmonary hypertension (PH) has been proved in previous studies. Experts suggest systolic pulmonary arterial pressure (SPAP) ⩾60 mmHg during exercise as a significant threshold of negative prognostic value in patients with MR. PURPOSE The aim of this study was to evaluate the changes of SPAP and to ascertain the determinants of exercise induced pulmonary hypertension (EIPH) in patients with asymptomatic primary MR. METHODS We performed a prospective study that included 50 patients with asymptomatic primary moderate to severe MR with preserved left ventricular ejection fraction (LV EF ⩾60%) at rest. They were divided into two groups according to the presence (PH group; n = 13) or absence (non-PH group; n = 37) of EIPH. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. RESULTS An increment of SPAP from rest to peak stress was higher in PH group (p < 0.001). Multivariate regression analysis showed that MR effective regurgitation orifice area (EROA; p = 0.008) and regurgitant volume (RVol; p = 0.006) contributed significantly to SPAP at rest. Higher increment of MR EROA during stress and worse parameters of LV diastolic function at rest (E, A, E/e') correlated significantly with higher SPAP during peak stress and they had a major role in predicting EIPH according to univariate logistic regression analysis. In ROC analysis SPAP >33.1 mmHg at rest could predict EIPH with 84.6% sensitivity and 87.1% specificity (95%CI 0.849-1.000; p < 0.001). CONCLUSIONS Parameters of MR severity (EROA and RVol) were significant determinants of SPAP at rest, while the increment of MR EROA during stress and parameters of resting LV diastolic function were the best predictors of significant EIPH.
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Affiliation(s)
- Rūta Žvirblytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aistė Montvilaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Tamulėnaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Saniukaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaškelytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,The Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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9
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Savaş G, Şahin Ö, Yaşan M, Karabiyik U, Kalay N, Doğan A, Elmali F, Oğuzhan A. Does the volume overload exaggerate the severity of mitral regurgitation in patients with decompensated heart failure? Turk J Med Sci 2020; 50:1552-1558. [PMID: 32892550 PMCID: PMC7605096 DOI: 10.3906/sag-2001-220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022] Open
Abstract
Background/aim Diagnosing and managing functional mitral regurgitation (MR) is often challenging and requires an integrated approach including a comprehensive echocardiographic examination. However, the effects of volume overload on the echocardiographic assessment of MR severity are uncertain. The purpose of this study was to weigh the effects of volume overload in the echocardiographic assessment of MR severity among patients with heart failure (HF). Materials and methods Twenty-nine patients with decompensated HF, who had moderate or severe MR, were included in the present study. The volume status and the N-terminal pro-B-type natriuretic peptide (proBNP) levels were recorded and the echocardiographic parameters were assessed. After the conventional treatment for HF, the proBNP levels and the echocardiographic parameters were assessed again. Results The mean age of the patients was 72 ± 9 years and the average hospitalization time was 10.9 ± 5.9 days. Between the beginning and the end of the treatment, there were significant reductions in the effective regurgitant orifice area (EROA) (0.36 ± 0.09 cm2 to 0.29 ± 0.09 cm2, P < 0.001), vena contracta (VC) (P < 0.001), the regurgitant volume (RV) (P < 0.001), and systolic pulmonary artery pressure (sPAP) (P < 0.001). Conclusion This is the first study to investigate the relationship of changes in severity of MR with volume-load by monitoring the proBNP levels among patients with HF. The present results demonstrated that volume reduction, as evidenced by a decline in the proBNP levels, was accompanied by a marked reduction in the EROA, VC, and the RV among patients with left ventricular dysfunction.
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Affiliation(s)
- Göktuğ Savaş
- Department of Cardiology, Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital, İstanbul, Turkey
| | - Ömer Şahin
- Department of Cardiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Mustafa Yaşan
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Uğur Karabiyik
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ali Doğan
- Department of Biostatistics and Bioinformatics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ferhan Elmali
- Department of Biostatistics and Bioinformatics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Abdurrahman Oğuzhan
- Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
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10
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Tarasoutchi F, Montera MW, Ramos AIDO, Sampaio RO, Rosa VEE, Accorsi TAD, Santis AD, Fernandes JRC, Pires LJT, Spina GS, Vieira MLC, Lavitola PDL, Ávila WS, Paixão MR, Bignoto T, Togna DJD, Mesquita ET, Esteves WADM, Atik F, Colafranceschi AS, Moises VA, Kiyose AT, Pomerantzeff PMA, Lemos PA, Brito Junior FSD, Weksler C, Brandão CMDA, Poffo R, Simões R, Rassi S, Leães PE, Mourilhe-Rocha R, Pena JLB, Jatene FB, Barbosa MDM, Abizaid A, Ribeiro HB, Bacal F, Rochitte CE, Fonseca JHDAPD, Ghorayeb SKN, Lopes MACQ, Spina SV, Pignatelli RH, Saraiva JFK. Update of the Brazilian Guidelines for Valvular Heart Disease - 2020. Arq Bras Cardiol 2020; 115:720-775. [PMID: 33111877 PMCID: PMC8386977 DOI: 10.36660/abc.20201047] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Flavio Tarasoutchi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | - Roney Orismar Sampaio
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Vitor Emer Egypto Rosa
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tarso Augusto Duenhas Accorsi
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Antonio de Santis
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - João Ricardo Cordeiro Fernandes
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Lucas José Tachotti Pires
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Guilherme S Spina
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Paulo de Lara Lavitola
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Walkiria Samuel Ávila
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Milena Ribeiro Paixão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Tiago Bignoto
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | | | | | - Fernando Atik
- Fundação Universitária de Cardiologia (FUC), São Paulo, SP - Brasil
| | | | | | | | | | - Pedro A Lemos
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | | | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ - Brasil
| | - Carlos Manuel de Almeida Brandão
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Robinson Poffo
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Ricardo Simões
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
| | | | | | - Ricardo Mourilhe-Rocha
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Pedro Ernesto, Rio de Janeiro, RJ - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | - Fabio Biscegli Jatene
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | - Alexandre Abizaid
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Henrique Barbosa Ribeiro
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Fernando Bacal
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração (Incor) do Hospital de Clínica da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | - José Francisco Kerr Saraiva
- Sociedade Campineira de Educação e Instrução Mantenedora da Pontifícia Universidade Católica de Campinas, Campinas, SP - Brasil
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11
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Papolla C, Adda J, Rique A, Habib G, Rieu R. In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method. J Am Soc Echocardiogr 2020; 33:838-847.e1. [DOI: 10.1016/j.echo.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
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12
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Right Ventricle Mechanics and Function during Stress in Patients with Asymptomatic Primary Moderate to Severe Mitral Regurgitation and Preserved Left Ventricular Ejection Fraction. Medicina (B Aires) 2020; 56:medicina56060303. [PMID: 32575723 PMCID: PMC7353882 DOI: 10.3390/medicina56060303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022] Open
Abstract
Background and objectives. Mitral regurgitation (MR) is usually dynamic and increasing with exertion. Stress may provoke symptoms, cause the progression of pulmonary hypertension (PH) and unmask subclinical changes of the left and right ventricle function. The aim of this study was to evaluate changes of right ventricle (RV) functional parameters during stress and to find out determinants of RV function in patients with MR. Materials and methods. We performed a prospective study that included patients with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) at rest (≥60%). Conventional 2D echocardiography at rest and during stress (bicycle ergometry) and offline speckle tracking analysis were performed. Results. 80 patients were included as MR (50) and control (30) groups. Conventional functional and myocardial deformation parameters of RV were similar in both groups at all stages of exercise (p > 0.05). The grade of MR (p = 0.004) and higher LV global longitudinal strain (p = 0.037) contributed significantly to the changes of tricuspid annular plane systolic excursion (TAPSE) from rest to peak stress. Changes of MR ERA from the rest to peak stress were related to RV free wall longitudinal strain (FWLS) and four chambers longitudinal stain (4CLS) at rest (p = 0.011; r = −0.459 and p = 0.001; r = −0.572, respectively). Significant correlations between LV EF, stroke volume, cardiac output and RV fractional area change, S′, TAPSE, FWLS, 4CLS were obtained. However, systolic pulmonary artery pressure and RV functional, deformation parameters were not related (p > 0.05). Conclusions. Functional parameters of LV during exercise and severity of MR were significant determinants of RV function while PH has no correlation with it in patients with primary asymptomatic moderate to severe MR.
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13
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Jacobs K, Rigdon J, Chan F, Cheng JY, Alley MT, Vasanawala S, Maskatia SA. Direct measurement of atrioventricular valve regurgitant jets using 4D flow cardiovascular magnetic resonance is accurate and reliable for children with congenital heart disease: a retrospective cohort study. J Cardiovasc Magn Reson 2020; 22:33. [PMID: 32404159 PMCID: PMC7222506 DOI: 10.1186/s12968-020-00612-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/02/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND 3D-time resolved flow (4DF) cardiovascular magnetic resonance (CMR) with retrospective analysis of atrioventricular valve regurgitation (AVVR) allows for internal validation by multiple direct and indirect methods. Limited data exist on direct measurement of AVVR by 4DF CMR in pediatric congenital heart disease (CHD). We aimed to validate direct measurement of the AVVR jet as accurate and reliable compared to the volumetric method (clinical standard by 2D CMR) and as a superior method of internal validation than the annular inflow method. METHODS We identified 44 consecutive patients with diverse CHD referred for evaluation of AVVR by CMR. 1.5 T or 3 T scanners, intravenous contrast, and a combination of parallel imaging and compressed sensing were used. Four methods of measuring AVVR volume (RVol) were used: volumetric method (VOL; the clinical standard) = stroke volume by 2D balanced steady-state free precession - semilunar valve forward flow (SLFF); annular inflow method (AIM) = atrioventricular valve forward flow [AVFF] - semilunar valve net flow (SLNF); and direct measurement (JET). AVFF was measured using static and retrospective valve tracking planes. SLFF, SLNF, AVFF, and JET were measured by 4DF phase contrast. Regurgitant fraction was calculated as [RVol/(RVol+SLNF)]× 100. Statistical methods included Spearman, Wilcoxon rank sum test/Student paired t-test, Bland Altman analysis, and intra-class coefficient (ICC), where appropriate. RESULTS Regurgitant fraction by JET strongly correlated with the indirect methods (VOL and AIM) (ρ = 0.73-0.80, p < 0.001) and was similar to VOL with a median difference (interquartile range) of - 1.5% (- 8.3-7.2%; p = 0.624). VOL had weaker correlations with AIM and JET (ρ = 0.69-0.73, p < 0.001). AIM underestimated RF by 3.6-6.9% compared to VOL and JET, p < 0.03. Intra- and inter- observer reliability were excellent for all methods (ICC 0.94-0.99). The mean (±standard deviation) inter-observer difference for VOL was 2.4% (±5.1%), p < 0.05. CONCLUSIONS In a diverse cohort of pediatric CHD, measurement of AVVR using JET is accurate and reliable to VOL and is a superior method of internal validation compared to AIM. This study supports use of 4DF CMR for measurement of AVVR, obviating need for expert prospective prescription during image acquisition by 2D CMR.
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Affiliation(s)
- Kimberley Jacobs
- Department of Pediatrics, Stanford University School of Medicine, 725 Welch Rd, Room G71, MC 5906, Palo Alto, CA, 94304, USA.
| | - Joseph Rigdon
- Department of Medicine, Quantitative Sciences Unit, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Frandics Chan
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Joseph Y Cheng
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Marcus T Alley
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shreyas Vasanawala
- Department of Radiology, Divisions of Pediatric Radiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
| | - Shiraz A Maskatia
- Department of Pediatrics, Divisions of Pediatric Cardiology and Cardiovascular Imaging, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA, 94305, USA
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14
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Maggiore P, Anastasius M, Huang AL, Blanke P, Leipsic J. Transcatheter Mitral Valve Repair and Replacement: Current Evidence for Intervention and the Role of CT in Preprocedural Planning-A Review for Radiologists and Cardiologists Alike. Radiol Cardiothorac Imaging 2020; 2:e190106. [PMID: 33778537 DOI: 10.1148/ryct.2020190106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/05/2019] [Accepted: 09/26/2019] [Indexed: 01/21/2023]
Abstract
The mitral valve is a complex structure with a three-dimensional saddle shape annulus. Mitral regurgitation occurs from leaflet coaptation failure that is either primary (a problem with the leaflets) or secondary (chamber dilatation in the setting of cardiomyopathy). There has been an increase in focus on transcatheter mitral valve interventions, for both mitral repair and replacement. These technologies have rapidly developed to provide treatment for a substantial number of patients with severe symptomatic mitral regurgitation who are at too high of a risk to undergo open heart surgery. CT assessment of the mitral valve has developed with equal rapidity, with regard to preprocedural planning for transcatheter therapies. This review will provide an overview of mitral valve anatomy, an update on the current transcatheter repair and replacement therapies, as well as a focused overview of the role of multislice CT in mitral assessment prior to intervention. © RSNA, 2020.
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Affiliation(s)
- Paul Maggiore
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Malcolm Anastasius
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Alex L Huang
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6
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15
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Cardiac magnetic resonance assessment of mitral regurgitation severity appears better than echocardiographic imaging. Int J Cardiovasc Imaging 2020; 36:889-897. [DOI: 10.1007/s10554-020-01772-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/07/2020] [Indexed: 01/03/2023]
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16
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Wang W, Wang Z, Li J, Gong K, Zhao L, Tang G, Fu X. The impact of different geometric assumption of mitral annulus on the assessment of mitral regurgitation volume by Doppler method. Cardiovasc Ultrasound 2020; 18:5. [PMID: 32005178 PMCID: PMC6995243 DOI: 10.1186/s12947-020-0187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mitral regurgitation volume (MRvol) by quantitative pulsed Doppler (QPD) method previously recommended suffers from geometric assumption error because of circular geometric assumption of mitral annulus (MA). Therefore, the aim of this study was to evaluate the impact of different geometric assumption of MA on the assessment of MRvol by two-dimensional transthoracic echocardiographic QPD method. Methods This study included 88 patients with varying degrees of mitral regurgitation (MR). The MRvol was evaluated by QPD method using circular or ellipse geometric assumption of MA. MRvol derived from effective regurgitant orifice area by real time three-dimensional echocardiography (RT3DE) multiplied by MR velocity-time integral was used as reference method. Results Assumption of a circular geometry of MA, QPD-MAA4C and QPD-MAPLAX overestimated the MRvol by a mean difference of 10.4 ml (P < 0.0001) and 22.5 ml (P < 0.0001) compared with RT3DE. Assumption of an ellipse geometry of MA, there was no significant difference of MRvol (mean difference = 1.7 ml, P = 0.0844) between the QPD-MAA4C + A2C and the RT3DE. Conclusions Assuming that the MA was circular geometry previously recommended, the MRvol by QPD-MAA4C was overestimated compared with the reference method. However, assuming that the MA was ellipse geometry, the MRvol by the QPD-MAA4C + A2C has no significant difference with the reference method.
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Affiliation(s)
- Wugang Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Zhibin Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Junfang Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Kun Gong
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Liang Zhao
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Guozhang Tang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Xiuxiu Fu
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China.
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17
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Mao W, Caballero A, Hahn RT, Sun W. Comparative quantification of primary mitral regurgitation by computer modeling and simulated echocardiography. Am J Physiol Heart Circ Physiol 2020; 318:H547-H557. [PMID: 31922890 DOI: 10.1152/ajpheart.00367.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Clinical investigations have demonstrated that mitral regurgitation (MR) quantification using echocardiography (echo) may significantly underestimate or overestimate the regurgitant volume, especially for two-dimensional (2D) echo. Computer modeling and simulated echo were conducted to evaluate the fundamental assumptions in the echo quantification of primary MR that is due to posterior mitral leaflet prolapse. The theoretical flaw of the proximal isovelocity surface area (PISA) method originates from the assumption that the MR flow rate is the product of the isovelocity surface area and aliasing velocity, which is only valid when the velocity vectors are perpendicular to the isovelocity surface. Other factors such as the Doppler angle effect, the view planes of 2D echo, and the single time instant of PISA were also analyzed. We find that the hemielliptic PISA method gives the smallest error for moderate and severe MR cases compared with other PISA methods. Compared with the PISA method, the volumetric technique (VT) is theoretically more robust. By considering correction factors that are caused by nonflat velocity profiles and the closing volume of the aortic valve, the accuracy of the VT method can be significantly improved. The corrected volumetric technique provides more accurate results compared with the PISA methods, especially for mild MR.NEW & NOTEWORTHY We evaluate the accuracy of common echocardiography techniques for the quantification of primary mitral regurgitations using computer modeling. The hemielliptic proximal isovelocity surface area (PISA) method gives the smallest error (within 15%) for moderate and severe mitral regurgitation cases compared with other PISA methods. The volumetric method is theoretically more robust than the PISA method. The accuracy of the volumetric method can be improved by a correction factor around 0.7 because of the nonflat velocity profiles and the closing volume of the aortic valve.
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Affiliation(s)
- Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Andrés Caballero
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
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18
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Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis. Int J Cardiovasc Imaging 2019; 36:279-289. [DOI: 10.1007/s10554-019-01713-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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19
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Collia D, Zovatto L, Pedrizzetti G. Analysis of mitral valve regurgitation by computational fluid dynamics. APL Bioeng 2019; 3:036105. [PMID: 31893254 PMCID: PMC6932856 DOI: 10.1063/1.5097245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/31/2019] [Indexed: 02/05/2023] Open
Abstract
The clinical syndrome of mitral insufficiency is a common consequence of mitral valve (MV) prolapse, when the MV leaflets do not seal the closed orifice and blood regurgitates back to the atrium during ventricular contraction. There are different types of MV prolapse that may influence the degree of regurgitation also in relation to the left ventricle (LV) geometry. This study aims to provide some insight into the fluid dynamics of MV insufficiency in view of improving the different measurements available in the clinical setting. The analysis is performed by a computational fluid dynamics model coupled with an asymptotic model of the MV motion. The computational fluid dynamics solution uses the immersed boundary method that is efficiently integrated with clinical imaging technologies. Healthy and dilated LVs obtained by multislice cardiac MRI are combined with simplified models of healthy and pathological MVs deduced from computed tomography and 4D-transesophageal echocardiography. The results demonstrated the properties of false regurgitation, blood that did not cross the open MV orifice and returns into the atrium during the backward motion of the MV leaflets, whose entity should be accounted when evaluating small regurgitation. The regurgitating volume is found to be proportional to the effective orifice area, with the limited dependence of the LV geometry and type of prolapse. These affect the percentage of old blood returning to the atrium which may be associated with thrombogenic risk.
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Affiliation(s)
- Dario Collia
- Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy
| | - Luigino Zovatto
- Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, P. Europa 1, 34127 Trieste, Italy
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20
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Hagendorff A, Doenst T, Falk V. Echocardiographic assessment of functional mitral regurgitation: opening Pandora's box? ESC Heart Fail 2019; 6:678-685. [PMID: 31347297 PMCID: PMC6676284 DOI: 10.1002/ehf2.12491] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 12/26/2022] Open
Abstract
Two recent trials of transcatheter mitral-valve repair in patients with functional mitral regurgitation (FMR) presented opposing results for the MitraClip® compared to medical therapy alone. The conflicting results gave rise to intensive discussions about assessment of mitral valve regurgitation (MR). A recent editorial viewpoint provided a potential explanation presenting a new pathophysiologic concept. However, the echocardiographic characterization of both trials' patients is inconsistent and the discussed concepts appear to suffer from plausibility weaknesses. It is well conceivable that limitations in the echocardiographic assessment of the trial patients introduced a bias regarding the selection of patients with severe (or less severe) MR that may be a more plausible explanation for the differences in outcome. We here illustrate our viewpoint regarding the two MitraClip trials and also illustrate the difficulties in assessing functional MR properly. It may indeed be "opening Pandora's box", but we will also make an attempt to provide a solution.
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Affiliation(s)
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Volkmar Falk
- Department of Cardiac Surgery, German Heart Center, Berlin, Germany
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21
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Shah M, Jorde UP. Percutaneous Mitral Valve Interventions (Repair): Current Indications and Future Perspectives. Front Cardiovasc Med 2019; 6:88. [PMID: 31355209 PMCID: PMC6640116 DOI: 10.3389/fcvm.2019.00088] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/14/2019] [Indexed: 01/17/2023] Open
Abstract
Mitral valve regurgitation (MR) is the commonest valvular abnormality encountered among adult patients with cardiac valvular disease and conveys significant morbidity and mortality. The mitral valve is a complex anatomical structure and etiology for regurgitation is classified as either primary or secondary MR. Identification of the etiology in severe MR is critical in determining the appropriate treatment strategy. Transcatheter mitral valve repair (TMVR) is a minimally invasive technique for treatment of selected patients with symptomatic chronic moderate-severe or severe (3 to 4+) MR. While surgery remains the mainstay for treatment in primary MR, several technological advances within the last decade have made transcatheter mitral valve intervention increasingly feasible and safe in clinical practice. Use of TMVR in patients with severe MR has successfully reduced patient symptoms, disease morbidity, improved quality of life, and facilitated reverse remodeling with potential for a survival advantage among certain patients with secondary MR. Recent randomized controlled trials on MitraClip use in secondary MR have reinvigorated interest in this disease and refocused our attention on optimizing patient selection and timing of intervention to maximize benefit from using such percutaneous devices. In our review, we discuss etiologies and pathophysiology in both acute MR and development of chronic severe MR. We discuss management strategies for MR among patients based on etiology, particularly percutaneous mitral valve interventional therapies. We perform an extensive review comparing and contrasting existing data on safety, efficacy, durability, and appropriate patient selection related to MitraClip implantation in both primary and secondary MR. Lastly, we explore percutaneous MV therapies beyond the MitraClip as we await larger scale trials on these devices prior to them making way into day-to-day practice.
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Affiliation(s)
- Mahek Shah
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, United States
| | - Ulrich P Jorde
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, United States
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22
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Marwick TH, Lancellotti P. The Keys to Personalizing the Decision for Valvular Intervention in Secondary Mitral Regurgitation. J Am Coll Cardiol 2019; 73:2518-2520. [PMID: 31118145 DOI: 10.1016/j.jacc.2019.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Thomas H Marwick
- Baker Heart and Diabetes Research Institute, Melbourne, Victoria, Australia.
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Jain P, Fabbro M. ACC Expert Consensus Decision Pathway on the Management of Mitral Regurgitation: A Review of the 2017 Document for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2019; 33:274-289. [DOI: 10.1053/j.jvca.2018.07.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Indexed: 12/12/2022]
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Grayburn PA, Sannino A, Packer M. Proportionate and Disproportionate Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2019; 12:353-362. [DOI: 10.1016/j.jcmg.2018.11.006] [Citation(s) in RCA: 290] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Chen L, Mantri N, Eng ML, Wung W, Smith TWR, Stripe BR, Fan D, Boyd WD, Low RI, Rogers JH, Singh GD. Intraprocedural direct left atrial and wedge pressure correlation during transcatheter mitral valve repair: Results from a single center registry. Catheter Cardiovasc Interv 2018; 94:165-170. [DOI: 10.1002/ccd.28035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/10/2018] [Accepted: 12/02/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Lily Chen
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Neha Mantri
- Division of Cardiovascular Medicine; Kaiser Permanente; San Francisco California
| | - Maia L. Eng
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - William Wung
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Thomas W. R. Smith
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Benjamin R. Stripe
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Dali Fan
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Walter D. Boyd
- Division of Cardiothoracic Surgery; UC Davis Medical Center; Sacramento California
| | - Reginald I. Low
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Jason H. Rogers
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
| | - Gagan D. Singh
- Division of Cardiovascular Medicine; UC Davis Medical Center; Sacramento California
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Weir-McCall JR, Blanke P, Naoum C, Delgado V, Bax JJ, Leipsic J. Mitral Valve Imaging with CT: Relationship with Transcatheter Mitral Valve Interventions. Radiology 2018; 288:638-655. [DOI: 10.1148/radiol.2018172758] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Weir-McCall
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Philipp Blanke
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Christopher Naoum
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Victoria Delgado
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jeroen J. Bax
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
| | - Jonathon Leipsic
- From the UBC Department of Medical Imaging, Centre for Heart Valve Innovation, St Paul’s Hospital and University of British Columbia, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6 (J.R.W.M., P.B., J.L.); Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, Australia (C.N.); and Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (V.D., J.J.B.)
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Sandoval Y, Sorajja P, Harris KM. Contemporary Management of Ischemic Mitral Regurgitation: A Review. Am J Med 2018; 131:887-895. [PMID: 29501456 DOI: 10.1016/j.amjmed.2018.01.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/19/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022]
Abstract
Ischemic mitral regurgitation occurs relatively frequently in patients with coronary artery disease and is associated with an increased long-term risk. The pathophysiology of ischemic mitral regurgitation is vexing and poses both diagnostic and therapeutic challenges, leading to the need for a comprehensive, multidisciplinary approach. The management is largely focused on medical therapy, and for those eligible, coronary revascularization or cardiac resynchronization therapy may be considered. In select patients, mitral valve surgery or catheter-based therapy may be undertaken with careful consideration of the underlying pathophysiology, surgical risk, and expected long-term outcomes. The appropriate evaluation of patients with ischemic mitral regurgitation involves a careful multidisciplinary approach that carefully considers symptomatology, the etiology and severity of the mitral regurgitation, and the assessment of comorbidities and operative risk to individualize the care of these patients.
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Affiliation(s)
- Yader Sandoval
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn; Division of Cardiology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minn
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn
| | - Kevin M Harris
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minn; Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minn.
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Kozlowski P, Rodriguez-Molares A, Tangen TA, Kristoffersen K, Torp H, Gerard O, Samset E. Adaptive Color Gain for Vena Contracta Quantification in Valvular Regurgitation. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1770-1777. [PMID: 29779888 DOI: 10.1016/j.ultrasmedbio.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 02/18/2018] [Accepted: 04/03/2018] [Indexed: 06/08/2023]
Abstract
Severe valvular regurgitation can lead to pulmonary hypertension, atrial fibrillation and heart failure. Vena contracta width is used to estimate the severity of the regurgitation. Parameters affecting visualization of color Doppler have a significant impact on the measurement. We propose a data-driven method for automated adjustment of color gain based on the peak power of the color Doppler signal in the vicinity of the vena contracta. A linear regression model trained on the peak power was used to predict the orifice diameter. According to our study, the color gain should be set to about 6 dB above where color Doppler data completely disappears from the image. Based on our method, orifices with reference diameters of 4, 6.5 and 8.5 mm were estimated with relative diameter errors within 18%, 12% and 14%, respectively.
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Affiliation(s)
- Pawel Kozlowski
- GE Vingmed Ultrasound, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway.
| | | | | | | | - Hans Torp
- Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Eigil Samset
- GE Vingmed Ultrasound, Oslo, Norway; Department of Informatics, University of Oslo, Oslo, Norway; Department of Cardiology, Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Norway
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Senior R, Becher H, Monaghan M, Agati L, Zamorano J, Vanoverschelde JL, Nihoyannopoulos P, Edvardsen T, Lancellotti P. Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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Affiliation(s)
- Roxy Senior
- Department of Cardiology, Royal Brompton Hospital, Imperial College, Sydney Street, London SW3 6NP, UK
| | | | | | | | - Jose Zamorano
- CIBERCV, University Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | | - Patrizio Lancellotti
- University of Liege Hospital, GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, Liege, Belgium
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A Comparative Assessment of Echocardiographic Parameters for Determining Primary Mitral Regurgitation Severity Using Magnetic Resonance Imaging as a Reference Standard. J Am Soc Echocardiogr 2018; 31:992-999. [PMID: 29921479 DOI: 10.1016/j.echo.2018.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND The American Society of Echocardiography (ASE) guidelines suggest the use of several echocardiographic methods to assess mitral regurgitation severity using an integrated approach, without guidance as to the weighting of each parameter. The purpose of this multicenter prospective study was to evaluate the recommended echocardiographic parameters against a reference modality and develop and validate a weighting for each echocardiographic measure of mitral regurgitation severity. METHODS This study included 112 patients who underwent evaluation with echocardiography and magnetic resonance imaging (MRI). Echocardiographic parameters recommended by the ASE were included and compared with MRI-derived regurgitant volume (MRI-RV). RESULTS Echocardiographic parameters that correlated best with MRI-RV were proximal isovelocity surface area (PISA) radius (r = 0.65, P < .0001), PISA-derived effective regurgitant orifice area (r = 0.65, P < .0001), left ventricular end-diastolic volume (r = 0.56, P < .0001), and PISA-derived regurgitant volume (r = 0.52, P < .0001). In the linear regression models PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet independently predicted MRI-RV. CONCLUSION Echocardiographic parameters of mitral regurgitation as recommended by the ASE had moderate correlations with MRI-RV. The best predictors of MRI-RV were PISA-derived effective regurgitant orifice area, PISA-derived regurgitant volume, left ventricular end-diastolic volume, and the presence of a flail leaflet, suggesting that these parameters should be weighted more heavily than other echocardiographic parameters in the application of the ASE-recommended integrated approach.
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31
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Kato A, Sandoval JP, Mroczek D, Chaturvedi R, Houle H, Georgescu B, Yoo SJ, Benson LN, Lee KJ. Automated 3-Dimensional Single-Beat Real-Time Volume Colour Flow Doppler Echocardiography in Children: A Validation Study of Right and Left Heart Flows. Can J Cardiol 2018; 34:726-735. [DOI: 10.1016/j.cjca.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/26/2018] [Accepted: 03/04/2018] [Indexed: 10/17/2022] Open
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32
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Jang JY, Kang JW, Yang DH, Lee S, Sun BJ, Kim DH, Song JM, Kang DH, Song JK. Impact of a Geometric Correction for Proximal Flow Constraint on the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method. J Cardiovasc Ultrasound 2018; 26:33-39. [PMID: 29629022 PMCID: PMC5881082 DOI: 10.4250/jcu.2018.26.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 02/25/2018] [Accepted: 02/26/2018] [Indexed: 11/22/2022] Open
Abstract
Background Overestimation of the severity of mitral regurgitation (MR) by the proximal isovelocity surface area (PISA) method has been reported. We sought to test whether angle correction (AC) of the constrained flow field is helpful to eliminate overestimation in patients with eccentric MR. Methods In a total of 33 patients with MR due to prolapse or flail mitral valve, both echocardiography and cardiac magnetic resonance image (CMR) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA (RVPISA), convergence angle (α) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying by α/180 (RVAC). RV measured by CMR (RVCMR) was used as a gold standard, which was calculated by the difference between total stroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. Results The correlation between RVCMR and RV by echocardiography was modest [RVCMR vs. RVPISA (r = 0.712, p < 0.001) and RVCMR vs. RVAC (r = 0.766, p < 0.001)]. However, RVPISA showed significant overestimation (RVPISA - RVCMR = 50.6 ± 40.6 mL vs. RVAC - RVCMR = 7.7 ± 23.4 mL, p < 0.001). The overall accuracy of RVPISA for diagnosis of severe MR, defined as RV ≥ 60 mL, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using RVAC (p = 0.028). Conclusion Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometric AC of the proximal constraint flow largely eliminates overestimation.
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Affiliation(s)
- Jeong Yoon Jang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Joon-Won Kang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Hyun Yang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Sahmin Lee
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae-Hee Kim
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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Jansen R, Wind AM, Cramer MJ, Nijhoff F, Agostoni P, Ramjankhan FZ, Suyker WJ, Stella PR, Chamuleau SAJ. Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2018. [PMID: 29524077 DOI: 10.1007/s10554-018-1328-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.
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Affiliation(s)
- R Jansen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A M Wind
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W J Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Nyman CB, Mackensen GB, Jelacic S, Little SH, Smith TW, Mahmood F. Transcatheter Mitral Valve Repair Using the Edge-to-Edge Clip. J Am Soc Echocardiogr 2018; 31:434-453. [PMID: 29482977 DOI: 10.1016/j.echo.2018.01.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 12/20/2022]
Abstract
Percutaneous intervention for mitral valve (MV) disease has been established as an alternative to open surgical MV repair in patients with prohibitive surgical risk. Multiple percutaneous approaches have been described and are in various stages of development. Edge-to-edge leaflet plication with the MitraClip (Abbott, Menlo Park, CA) is currently the only Food and Drug Administration-approved device specifically for primary or degenerative lesions. Use of the edge-to-edge clip for secondary mitral regurgitation is currently under investigation and may result in expanded indications. Echocardiography has significantly increased our understanding of the anatomy of the MV and provided us with the ability to classify and quantify the associated mitral regurgitation. For percutaneous interventions of the MV, transesophageal echocardiography imaging is used for patient screening, intraprocedural guidance, and confirmation of the result. Optimal outcomes require the echocardiographer and the proceduralist to have a thorough understanding of intra-atrial septal and MV anatomy, as well as an appreciation for the key points and potential pitfalls of each of the procedural steps. With increasing experience, more complex valvular pathology can be successfully percutaneously treated. In addition to two-dimensional echocardiography, advances in three-dimensional echocardiography and fusion imaging will continue to support the refinement of current technologies, the expansion of clinical applications, and the development of novel devices.
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Affiliation(s)
- Charles B Nyman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Srdjan Jelacic
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington
| | - Stephen H Little
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Thomas W Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, UC Davis Medical Center, Sacramento, California
| | - Feroze Mahmood
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Zürcher F, Brugger N, Jahren SE, de Marchi SF, Seiler C. Quantification of Multiple Mitral Regurgitant Jets: An In Vitro Validation Study Comparing Two- and Three-Dimensional Proximal Isovelocity Surface Area Methods. J Am Soc Echocardiogr 2018; 30:511-521. [PMID: 28274714 DOI: 10.1016/j.echo.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND The accuracy of the proximal isovelocity surface area (PISA) method for the quantification of mitral regurgitation (MR), in the case of multiple jets, is unknown. The aim of this study was to evaluate different two-dimensional (2D) and three-dimensional (3D) PISA methods using 3D color Doppler data sets. METHODS Several regurgitant volumes (Rvols) were simulated using a pulsatile pump connected to a phantom equipped with single and double regurgitant orifices of different sizes and interspaces. A flowmeter served as the reference method. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were used to acquire the 3D data sets. Offline, Rvols were calculated by 2D PISA methods based on hemispheric and hemicylindric assumptions and by 3D integrated PISA. RESULTS A fusion of the PISA was observed in the setting of narrow-spaced regurgitant orifices; compared with flowmeter, Rvol was underestimated using the single hemispheric PISA model (TTE: Bland-Altman bias ± limit of agreement, -17.5 ± 8.9 mL; TEE: -15.9 ± 7.3 mL) and overestimated using the double hemispheric PISA model (TTE: +7.1 ± 14.6 mL; TEE: +10.4 ± 11.9 mL). The combined approach (hemisphere for single orifice, hemicylinder with two bases for nonfused PISAs, and hemicylinder with one base for fused PISAs) was more precise (TTE: -3.4 ± 6.3 mL; TEE: -1.9 ± 5.6 mL). Three-dimensional integrated PISA was the most accurate method to quantify Rvol (TTE: -2.1 ± 6.5 mL; TEE -3.2 ± 4.8 mL). CONCLUSIONS In the setting of double MR orifices, the 2D combined approach and integrated 3D PISA appear to be superior as compared with the conventional hemispheric method, thus providing tools for the challenging quantification of MR with multiple jets.
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Affiliation(s)
- Fabian Zürcher
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Hôpital Fribourgeois, Fribourg, Switzerland
| | | | | | - Christian Seiler
- Department of Cardiology, University Hospital, Bern, Switzerland.
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Argulian E, Seetharam K. Echocardiographic 3D-guided 2D planimetry in quantifying left-sided valvular heart disease. Echocardiography 2018; 35:695-706. [PMID: 29420834 DOI: 10.1111/echo.13828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Echocardiographic 3D-guided 2D planimetry can improve the accuracy of valvular disease assessment. Acquisition of 3D pyramidal dataset allows subsequent multiplanar reconstruction with accurate orthogonal plane alignment to obtain the correct borders of an anatomic orifice or flow area. Studies examining the 3D-guided 2D planimetry approach in left-sided valvular heart disease were identified and reviewed. The strongest evidence exists for estimating mitral valve area in patients with rheumatic mitral valve stenosis and vena contracta area in patients with mitral regurgitation (both primary and secondary). 3D-guided approach showed excellent feasibility and reproducibility in most studies, as well as time efficiency and good correlation with reference and comparator methods. Therefore, 3D-guided 2D planimetry can be used as an important clinical tool in quantifying left-sided valvular heart disease, especially mitral valve disorders.
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Uretsky S, Argulian E, Narula J, Wolff SD. Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation. J Am Coll Cardiol 2018; 71:547-563. [DOI: 10.1016/j.jacc.2017.12.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 02/04/2023]
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Matiasz R, Rigolin VH. 2017 Focused Update for Management of Patients With Valvular Heart Disease: Summary of New Recommendations. J Am Heart Assoc 2018. [PMCID: PMC5778970 DOI: 10.1161/jaha.117.007596] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Richard Matiasz
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Vera H. Rigolin
- Division of Cardiology, Department of Medicine, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL
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Katz WE, Conrad Smith AJ, Crock FW, Cavalcante JL. Echocardiographic evaluation and guidance for MitraClip procedure. Cardiovasc Diagn Ther 2017; 7:616-632. [PMID: 29302467 PMCID: PMC5752829 DOI: 10.21037/cdt.2017.07.04] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/12/2017] [Indexed: 11/06/2022]
Abstract
Transcatheter mitral valve repair using the MitraClip system (Abbott, Abbott Park, Il, USA) has become a world-wide, well-established therapeutic alternative to treat symptomatic patients with severe mitral regurgitation and prohibitive surgical risk. This article offers a comprehensive review of the important clinical and imaging aspects related to the patient selection, imaging evaluation and intraprocedural guidance for optimal results using this transcatheter device therapy. This article provides an updated framework for the interested practitioners summarizing the current understanding and applications for this device based on the current literature and growing experience of this technique.
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Affiliation(s)
- William E Katz
- Division of Cardiovascular Diseases, Department of Medicine, UPMC Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anson J Conrad Smith
- Division of Cardiovascular Diseases, Department of Medicine, UPMC Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frederick W Crock
- Division of Cardiovascular Diseases, Department of Medicine, UPMC Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - João L Cavalcante
- Division of Cardiovascular Diseases, Department of Medicine, UPMC Heart & Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
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41
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O'Driscoll JM, Gargallo-Fernandez P, Araco M, Perez-Lopez M, Sharma R. Baseline mitral regurgitation predicts outcome in patients referred for dobutamine stress echocardiography. Int J Cardiovasc Imaging 2017; 33:1711-1721. [PMID: 28685313 PMCID: PMC5682847 DOI: 10.1007/s10554-017-1163-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/08/2017] [Indexed: 12/22/2022]
Abstract
A number of parameters recorded during dobutamine stress echocardiography (DSE) are associated with worse outcome. However, the relative importance of baseline mitral regurgitation (MR) is unknown. The aim of this study was to assess the prevalence and associated implications of functional MR with long-term mortality in a large cohort of patients referred for DSE. 6745 patients (mean age 64.9 ± 12.2 years) were studied. Demographic, baseline and peak DSE data were collected. All-cause mortality was retrospectively analyzed. DSE was successfully completed in all patients with no adverse outcomes. MR was present in 1019 (15.1%) patients. During a mean follow up of 5.1 ± 1.8 years, 1642 (24.3%) patients died and MR was significantly associated with increased all-cause mortality (p < 0.001). With Kaplan-Meier analysis, survival was significantly worse for patients with moderate and severe MR (p < 0.001). With multivariate Cox regression analysis, moderate and severe MR (HR 2.78; 95% CI 2.17-3.57 and HR 3.62; 95% CI 2.89-4.53, respectively) were independently associated with all-cause mortality. The addition of MR to C statistic models significantly improved discrimination. MR is associated with all-cause mortality and adds incremental prognostic information among patients referred for DSE. The presence of MR should be taken into account when evaluating the prognostic significance of DSE results.
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Affiliation(s)
- Jamie M O'Driscoll
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
- School of Human and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - Paula Gargallo-Fernandez
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Marco Araco
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Manuel Perez-Lopez
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - Rajan Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK.
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42
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Faletra FF, Berrebi A, Pedrazzini G, Leo LA, Paiocchi VL, Cautilli G, Casso G, Cassina T, Moccetti T, Malouf JF. 3D transesophageal echocardiography: A new imaging tool for assessment of mitral regurgitation and for guiding percutaneous edge-to-edge mitral valve repair. Prog Cardiovasc Dis 2017; 60:305-321. [DOI: 10.1016/j.pcad.2017.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/17/2022]
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Müller S, Menciotti G, Borgarelli M. Anatomic regurgitant orifice area obtained using 3D-echocardiography as an indicator of severity of mitral regurgitation in dogs with myxomatous mitral valve disease. J Vet Cardiol 2017; 19:433-440. [PMID: 28964709 DOI: 10.1016/j.jvc.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To determine feasibility and repeatability of measuring the anatomic regurgitant orifice area (AROA) using real-time three-dimensional transthoracic echocardiography (RT3DE) in dogs with myxomatous mitral valve disease (MMVD), and to investigate differences in the AROA of dogs with different disease severity and in different American College of Veterinary Internal Medicine (ACVIM) stages. ANIMALS Sixty privately-owned dogs diagnosed with MMVD. METHODS The echocardiographic database of our institution was retrospectively searched for dogs diagnosed with MMVD and RT3DE data set acquisition. Dogs were classified into mild, moderate, or severe MMVD according to a Mitral Regurgitation Severity Score (MRSS), and into stage B1, B2 or C according to ACVIM staging. The RT3DE data sets were imported into dedicated software and a short axis plane crossing the regurgitant orifice was used to measure the AROA. Feasibility, inter- and intra-observer variability of measuring the AROA was calculated. Differences in the AROA between dogs in different MRSS and ACVIM stages were investigated. RESULTS The AROA was measurable in 60 data sets of 81 selected to be included in the study (74%). The inter- and intra-observer coefficients of variation were 26% and 21%, respectively. The AROA was significantly greater in dogs with a severe MRSS compared with dogs with mild MRSS (p=0.045). There was no difference between the AROA of dogs in different ACVIM clinical stages. CONCLUSIONS Obtaining the AROA using RT3DE is feasible and might provide additional information to stratify mitral regurgitation severity in dogs with MMVD. Diagnostic and prognostic utility of the AROA deserves further investigation.
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Affiliation(s)
- S Müller
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - G Menciotti
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA.
| | - M Borgarelli
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Blacksburg, VA 24061, USA
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Jansen R, Hart EA, Peters M, Urgel K, Kluin J, Tietge WJ, Zwart K, Sybrandy KC, Cramer MJM, Chamuleau SAJ. An easy-to-use scoring index to determine severity of mitral regurgitation by 2D echocardiography in clinical practice. Echocardiography 2017; 34:1275-1283. [PMID: 28833463 DOI: 10.1111/echo.13636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Mitral regurgitation (MR) grading by two-dimensional transthoracic echocardiography is challenging, but important to determine the best treatment strategy in patients with MR. Current guidelines advocate an integrative approach, although no recommendation is provided on how to do so. An easy-to-use index will be helpful for standardized and reproducible MR grading. METHODS Eleven echocardiographic parameters were retrospectively evaluated in 145 patients with moderate or severe MR. Parameters were scored positive or negative for severe MR, where expert panel consensus reading was considered as the reference standard. Logistic regression was performed, and adjusted coefficients were used to create a risk score for severe MR per patient (ROSE-index). The best cutoff with corresponding predictive values was determined. RESULTS Eighty-two percent of all parameters could be determined. Multivariable analysis revealed five parameters that remained significant predictors for severe MR: morphology, jet characteristics, vena contracta, systolic reversal, and left ventricular dimensions. With different weighing, a total score of 8 could be obtained. Median total ROSE-index score for moderate (2.0) and severe MR (5.0) did significantly differ. The cutoff score (≥4) revealed sensitivity 0.84 and specificity 0.83 to diagnose severe MR. Negative predictive value was 100% for score 0 and 1; score 6-8 showed a 100% positive predictive value. Inter- and intra-observer agreements were excellent (K-values >0.80). CONCLUSION Here, we propose an easy-to-use tool for integrated analysis of guideline parameters to assess MR severity. Using this so-called ROSE-index revealed reliable and reproducible assessment of severe MR (cutoff≥4) that may be helpful for clinical decision making.
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Affiliation(s)
- Rosemarijn Jansen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Einar A Hart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Max Peters
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kim Urgel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Wouter J Tietge
- Department of Cardiology, Diaconessenhuis Hospital Leiden, Leiden, The Netherlands
| | - Koen Zwart
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten C Sybrandy
- Department of Cardiology, St. Jansdal Hospital Harderwijk, Harderwijk, The Netherlands
| | - Maarten J M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Thaden JJ, Tsang MY, Ayoub C, Padang R, Nkomo VT, Tucker SF, Cassidy CS, Bremer M, Kane GC, Pellikka PA. Association Between Echocardiography Laboratory Accreditation and the Quality of Imaging and Reporting for Valvular Heart Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006140. [DOI: 10.1161/circimaging.117.006140] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 06/21/2017] [Indexed: 11/16/2022]
Abstract
Background—
It is presumed that echocardiographic laboratory accreditation leads to improved quality, but there are few data. We sought to compare the quality of echocardiographic examinations performed at accredited versus nonaccredited laboratories for the evaluation of valvular heart disease.
Methods and Results—
We enrolled 335 consecutive valvular heart disease subjects who underwent echocardiography at our institution and an external accredited or nonaccredited institution within 6 months. Completeness and quality of echocardiographic reports and images were assessed by investigators blinded to the external laboratory accreditation status and echocardiographic results. Compared with nonaccredited laboratories, accredited sites more frequently reported patient sex (94% versus 78%;
P
<0.001), height and weight (96% versus 63%;
P
<0.001), blood pressure (86% versus 39%;
P
<0.001), left ventricular size (96% versus 83%;
P
<0.001), right ventricular size (94% versus 80%;
P
=0.001), and right ventricular function (87% versus 73%;
P
=0.006). Accredited laboratories had higher rates of complete and diagnostic color (58% versus 35%;
P
=0.002) and spectral Doppler imaging (45% versus 21%;
P
<0.0001). Concordance between external and internal grading of external studies was improved when diagnostic quantification was performed (85% versus 69%;
P
=0.003), and in patients with mitral regurgitation, reproducibility was improved with higher quality color Doppler imaging.
Conclusions—
Accredited echocardiographic laboratories had more complete reporting and better image quality, while echocardiographic quantification and color Doppler image quality were associated with improved concordance in grading valvular heart disease. Future quality improvement initiatives should highlight the importance of high-quality color Doppler imaging and echocardiographic quantification to improve the accuracy, reproducibility, and quality of echocardiographic studies for valvular heart disease.
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Affiliation(s)
- Jeremy J. Thaden
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Michael Y. Tsang
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Chadi Ayoub
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Ratnasari Padang
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T. Nkomo
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Stephen F. Tucker
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Cynthia S. Cassidy
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Merri Bremer
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Garvan C. Kane
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Patricia A. Pellikka
- From the Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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Xu B, Mehra R. The hemodynamic impact of acute nasal continuous positive airway pressure treatment in hypertrophic cardiomyopathy: is it safe? J Thorac Dis 2017; 9:1409-1411. [PMID: 28740644 DOI: 10.21037/jtd.2017.05.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Bo Xu
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Reena Mehra
- Sleep Disorders Center, Neurologic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Jamil M, Ahmad O, Poh KK, Yap CH. Feasibility of Ultrasound-Based Computational Fluid Dynamics as a Mitral Valve Regurgitation Quantification Technique: Comparison with 2-D and 3-D Proximal Isovelocity Surface Area-Based Methods. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1314-1330. [PMID: 28434658 DOI: 10.1016/j.ultrasmedbio.2017.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/09/2017] [Accepted: 02/12/2017] [Indexed: 06/07/2023]
Abstract
Current Doppler echocardiography quantification of mitral regurgitation (MR) severity has shortcomings. Proximal isovelocity surface area (PISA)-based methods, for example, are unable to account for the fact that ultrasound Doppler can measure only one velocity component: toward or away from the transducer. In the present study, we used ultrasound-based computational fluid dynamics (Ub-CFD) to quantify mitral regurgitation and study its advantages and disadvantages compared with 2-D and 3-D PISA methods. For Ub-CFD, patient-specific mitral valve geometry and velocity data were obtained from clinical ultrasound followed by 3-D CFD simulations at an assumed flow rate. We then obtained the average ratio of the ultrasound Doppler velocities to CFD velocities in the flow convergence region, and scaled CFD flow rate with this ratio as the final measured flow rate. We evaluated Ub-CFD, 2-D PISA and 3-D PISA with an in vitro flow loop, which featured regurgitation flow through (i) a simplified flat plate with round orifice and (ii) a 3-D printed realistic mitral valve and regurgitation orifice. The Ub-CFD and 3-D PISA methods had higher precision than the 2-D PISA method. Ub-CFD had consistent accuracy under all conditions tested, whereas 2-D PISA had the lowest overall accuracy. In vitro investigations indicated that the accuracy of 2-D and 3-D PISA depended significantly on the choice of aliasing velocity. Evaluation of these techniques was also performed for two clinical cases, and the dependency of PISA on aliasing velocity was similarly observed. Ub-CFD was robustly accurate and precise and has promise for future translation to clinical practice.
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Affiliation(s)
- Muhammad Jamil
- Department of Biomedical Engineering, National University of Singapore, Singapore
| | - Omar Ahmad
- Comsats Institute of Information Technology, Islamabad, Pakistan
| | - Kian Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Choon Hwai Yap
- Department of Biomedical Engineering, National University of Singapore, Singapore.
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Berdejo J, Shiota M, Mihara H, Itabashi Y, Utsunomiya H, Shiota T. Vena contracta analysis by color Doppler three-dimensional transesophageal echocardiography shows geometrical differences between prolapse and pseudoprolapse in eccentric mitral regurgitation. Echocardiography 2017; 34:683-689. [PMID: 28317206 DOI: 10.1111/echo.13508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Evaluation of eccentric mitral regurgitation (MR) remains extremely difficult and the role played by its etiology, functional or degenerative, is not well understood. This study aimed to demonstrate the value of three-dimensional transesophageal echocardiography (3DTEE) in the evaluation of eccentric MR identifying geometric differences in the vena contracta area between functional and degenerative etiologies. METHODS AND RESULTS We studied 61 patients with eccentric MR (30 functional and 31 degenerative). Regurgitant orifice area was determined by the two-dimensional proximal isovelocity surface area (2DPISA) and the 3DTEE methods. The ratio between maximum and minimum lengths of the vena contracta was calculated in each patient. Effective regurgitant orifice area by the 2DPISA method was smaller than that estimated by 3DTEE (0.56±0.21 vs 0.72±0.25 cm2 ). A better correlation between both methods was seen in degenerative mitral regurgitation (DMR; r=.83), with a mean underestimation of 8.2% by the 2DPISA method. A much worse correlation was found in functional mitral regurgitation (FMR; r=.39), where a mean underestimation by the 2DPISA method of 29.1% was observed. There was a more elongated and curved vena contracta in FMR compared to that in DMR (length ratio: 3.4±1.0 vs 2.2±0.7, P<.0001). CONCLUSION Three-dimensional transesophageal echocardiography identifies a more elongated regurgitant orifice in eccentric FMR compared to that in eccentric DMR. This difference may explain the greater underestimation of effective regurgitant orifice area by the 2DPISA method in FMR. High-quality 3DTEE analysis of vena contracta area would be a highly recommended alternative.
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Affiliation(s)
| | - Maiko Shiota
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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Toma M, Bloodworth CH, Pierce EL, Einstein DR, Cochran RP, Yoganathan AP, Kunzelman KS. Fluid-Structure Interaction Analysis of Ruptured Mitral Chordae Tendineae. Ann Biomed Eng 2017; 45:619-631. [PMID: 27624659 PMCID: PMC5332285 DOI: 10.1007/s10439-016-1727-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 09/02/2016] [Indexed: 10/21/2022]
Abstract
The chordal structure is a part of mitral valve geometry that has been commonly neglected or simplified in computational modeling due to its complexity. However, these simplifications cannot be used when investigating the roles of individual chordae tendineae in mitral valve closure. For the first time, advancements in imaging, computational techniques, and hardware technology make it possible to create models of the mitral valve without simplifications to its complex geometry, and to quickly run validated computer simulations that more realistically capture its function. Such simulations can then be used for a detailed analysis of chordae-related diseases. In this work, a comprehensive model of a subject-specific mitral valve with detailed chordal structure is used to analyze the distinct role played by individual chordae in closure of the mitral valve leaflets. Mitral closure was simulated for 51 possible chordal rupture points. Resultant regurgitant orifice area and strain change in the chordae at the papillary muscle tips were then calculated to examine the role of each ruptured chorda in the mitral valve closure. For certain subclassifications of chordae, regurgitant orifice area was found to trend positively with ruptured chordal diameter, and strain changes correlated negatively with regurgitant orifice area. Further advancements in clinical imaging modalities, coupled with the next generation of computational techniques will enable more physiologically realistic simulations.
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Affiliation(s)
- Milan Toma
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Charles H Bloodworth
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Eric L Pierce
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Daniel R Einstein
- Department of Mechanical Engineering, St. Martin's University, 5000 Abbey Way SE, Lacey, WA, 98503, USA
| | - Richard P Cochran
- Department of Mechanical Engineering, University of Maine, 219 Boardman Hall, Orono, ME, 04469-5711, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
| | - Karyn S Kunzelman
- Department of Mechanical Engineering, University of Maine, 219 Boardman Hall, Orono, ME, 04469-5711, USA
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50
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Sinning JM. Trying to square the circle? Integration of computed tomography data for the evaluation of mitral regurgitation. Eur Heart J 2017; 38:2227-2229. [DOI: 10.1093/eurheartj/ehw685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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