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Begic Z, Djukic M, Begic E, Aziri B, Begic N, Badnjevic A. Chronic mild to moderate mitral regurgitation will not have an impact on left atrial strain parameters in the pediatric population. Technol Health Care 2024:THC240768. [PMID: 38875065 DOI: 10.3233/thc-240768] [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: 06/16/2024]
Abstract
BACKGROUND Left atrial strain (LAS) analysis represents a newer non-invasive, sensitive and specific technique for assessing left atrial (LA) function and early detection of its deformation and dysfunction. However, its applicability in mitral regurgitation (MR) in pediatric population remains unexplored, raising pertinent questions regarding its potential role in evaluating the severity and progression of the disease. OBJECTIVE To investigate the impact of chronic MR in children and adolescents on LA remodeling and function. METHODS The study included 100 participants. Patients with primary and secondary chronic MR lasting at least 5 years fit our inclusion criteria. The exclusion criteria from the study were: patients with functional mitral regurgitation due to primary cardiomyopathies, patients with artificial mitral valve, patients with MR who had previously undergone surgery due to obstructive lesions of the left heart (aortic stenosis, coarctation of the aorta), patients with significant atrial rhythm disorders (atrial fibrillation, atrial flutter). The echocardiographic recordings were conducted by two different cardiologists. Outcome data was reported as mean and standard deviation (SD) or median and interquartile range (Q1-Q3). RESULTS The study included 100 participants, of whom 50 had MR and the remaining 50 were without MR. The average age of all participants was 15.8 ± 1.2 years, with a gender distribution of 37 males and 63 females. There was a significant difference in the values of LA volume index (LAVI), which were higher in patients with MR (p= 0.0001), S/D ratio (and parameters S and D; p= 0.001, p= 0.0001, p= 0.013), mitral annulus radius (p= 0.0001), E/A ratio (p= 0.0001), as well as septal e' (m/s), lateral e' (m/s), and average E/e' ratio, along with the values of TV peak gradient and LV global longitudinal strain (%). There was no significant difference in LA strain parameters, nor in LA stiffness index (LASI). CONCLUSION Our findings revealed significant differences in several echocardiographic parameters in pediatric patients with MR relative to those without MR, providing insight into the multifaceted cardiac structural and functional effects of MR in this vulnerable population.
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Affiliation(s)
- Zijo Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Milan Djukic
- Department of Cardiology, University Children's Hospital, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Edin Begic
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
- Department of Cardiology, General Hospital "Prim. Dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Nedim Begic
- Department of Cardiology, Pediatric Clinic, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Almir Badnjevic
- Verlab Research Institute for Biomedical Engineering, Medical Devices and Artificial Intelligence, Sarajevo, Bosnia and Herzegovina
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Shuvy M, Maisano F, Strauss BH. Transcatheter Mitral Edge-to-Edge Repair for Treatment of Acute Mitral Regurgitation. Can J Cardiol 2023; 39:1382-1389. [PMID: 37209883 DOI: 10.1016/j.cjca.2023.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 05/22/2023] Open
Abstract
Acute mitral regurgitation (AMR) is a medical emergency which may lead to rapid clinical deterioration and is associated with high morbidity and mortality. The severity of the clinical presentation varies according to several factors, ranging from cardiogenic shock to a milder presentation. The medical management of AMR includes intravenous diuretics, vasodilators, inotropic support, and potentially mechanical support to stabilise patients. Patients persisting with refractory symptoms despite optimal medical therapy are considered for surgical intervention, but high-risk patients deemed to be inoperable frequently experience poor outcomes. This review highlights the variety of clinical presentations of AMR and the pitfalls in diagnosis and management. The emerging role of transcatheter edge-to-edge repair (TEER), particularly in high-risk patients early after myocardial infarction requiring urgent intervention, has demonstrated feasibility and promising efficacy. TEER is well tolerated and improves hemodynamic parameters in AMR. In a recent analysis, the in-hospital and 1-year mortality rates were significantly higher with surgical mitral interventions compared with TEER. The global TEER experience for treating AMR is encouraging, with reports indicating improved clinical outcomes in high-risk patients and its potential as a bridge to recovery. Early recognition of AMR, validated criteria for patient selection, optimal timing of the intervention as well as long-term outcomes and additional prospective data should be addressed in future studies.
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Affiliation(s)
- Mony Shuvy
- Jesselson Integrated Heart Centre, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | | | - Bradley H Strauss
- Reichmann Chair in Cardiovascular Research, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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3
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Arzuffi L, Mandurino-Mirizzi A, Magrini G, Frassica R, Disabato G, Ferlini M, Gazzoli F, Scelsi L, Turco A, Munafò A, Ghio S, Ferrario M, Oltrona-Visconti L, Crimi G. Impact of mitral transcatheter edge-to-edge repair on pulmonary vein flow in patients with functional mitral regurgitation. J Cardiovasc Med (Hagerstown) 2023; 24:206-208. [PMID: 36729687 DOI: 10.2459/jcm.0000000000001417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Luca Arzuffi
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Giandomenico Disabato
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | | | - Andrea Munafò
- Division of Cardiology
- University of Pavia, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Gabriele Crimi
- Division of Cardiology
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Genova, Italy - IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, Genova, Italy
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Itakura K, Utsunomiya H, Takemoto H, Takahari K, Ueda Y, Izumi K, Ikenaga H, Hidaka T, Fukuda Y, Nakano Y. Prevalence, distribution, and determinants of pulmonary venous systolic flow reversal in severe mitral regurgitation. Eur Heart J Cardiovasc Imaging 2021; 22:964-973. [PMID: 34041531 DOI: 10.1093/ehjci/jeab098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 04/29/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS This study aimed to evaluate the prevalence and distribution of pulmonary venous systolic flow reversal (PVSFR) in patients with severe mitral regurgitation (MR), and to examine the relationship between PVSFR profile and cardiac parameters. METHODS AND RESULTS A total of 125 patients with severe MR who had transoesophageal echocardiography (TOE) performed were reviewed. Of these, 121 (96.8%) patients showed all four pulmonary venous (PV) flows by TOE. They were categorized into three groups by the MR aetiology: degenerative MR (DMR) (n = 72), ventricular functional MR (V-FMR) (n = 20), and atrial functional MR (A-FMR) (n = 16). Eighteen (16.7%) patients had PVSFR in all four PVs. Twenty-nine (26.9%) had PVSFR in three PVs, 23 (21.3%) in two PVs, and 23 (21.3%) in one PV. PVSFR appeared at right PVs more frequently compared with left PVs. A high number of PVSFR was significantly correlated with higher pulmonary capillary wedge pressure (PCWP) and 3D vena contracta area (3D-VCA). With regard to MR aetiology, the number of PVSFRs was correlated with high 3D-VCA in patients with DMR and A-FMR, while it was correlated with high PCWP in patients with V-FMR. Laminar-type PVSFR appeared more frequently in FMR compared with DMR, and it had a relationship with higher PCWP and lower right ventricular fractional area change (RVFAC). CONCLUSION All four PV were detected in 96.8%, and 16.8% patients had PVSFR in all four PVs. PCWP and 3D-VCA were correlated with the number of PVSFRs in severe MR patients. Laminar-type PVSFR was related to higher PCWP and lower RVFAC.
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Affiliation(s)
- Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hajime Takemoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takayuki Hidaka
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Robinson S, Ring L, Augustine DX, Rekhraj S, Oxborough D, Lancellotti P, Rana B. The assessment of mitral valve disease: a guideline from the British Society of Echocardiography. Echo Res Pract 2021; 8:G87-G136. [PMID: 34061768 PMCID: PMC8495880 DOI: 10.1530/erp-20-0034] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022] Open
Abstract
Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in Western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is, therefore, one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic, transoesophageal and exercise stress echocardiography play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease, and for helping to determine the appropriate timing and method of intervention. This guideline from the British Society of Echocardiography (BSE) describes the assessment of mitral regurgitation and mitral stenosis, and replaces previous BSE guidelines that describe the echocardiographic assessment of mitral anatomy prior to mitral valve repair surgery and percutaneous mitral valvuloplasty. It provides a comprehensive description of the imaging techniques (and their limitations) employed in the assessment of mitral valve disease. It describes a step-wise approach to identifying: aetiology and mechanism, disease severity, reparability and secondary effects on chamber geometry, function and pressures. Advanced echocardiographic techniques are described for both transthoracic and transoesophageal modalities, including TOE and exercise testing.
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Affiliation(s)
- Shaun Robinson
- S Robinson, Echocardiography, North West Anglia NHS Foundation Trust, Peterborough, PE3 9GZ, United Kingdom of Great Britain and Northern Ireland
| | - Liam Ring
- L Ring, Cardiology Department, West Suffolk Hospital NHS Trust, Bury St Edmunds, United Kingdom of Great Britain and Northern Ireland
| | - Daniel X Augustine
- D Augustine, Cardiology, Royal United Hospital Bath, Bath, United Kingdom of Great Britain and Northern Ireland
| | - Sushma Rekhraj
- S Rekhraj, Cardiology Department, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - David Oxborough
- D Oxborough, Research Institute for Sports and Exercise Physiology, Liverpool John Moores University, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | | | - Bushra Rana
- B Rana, Cardiology, Hammersmith Hospitals NHS Trust, London, United Kingdom of Great Britain and Northern Ireland
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Ikenaga H, Yoshida J, Hayashi A, Nagaura T, Yamaguchi S, Rader F, Siegel RJ, Kar S, Shiota T. Usefulness of Intraprocedural Pulmonary Venous Flow for Predicting Recurrent Mitral Regurgitation and Clinical Outcomes After Percutaneous Mitral Valve Repair With the MitraClip. JACC Cardiovasc Interv 2019; 12:140-150. [DOI: 10.1016/j.jcin.2018.09.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/17/2018] [Accepted: 09/25/2018] [Indexed: 11/29/2022]
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Pant S, Corsini C, Baker C, Hsia TY, Pennati G, Vignon-Clementel IE. A Lumped Parameter Model to Study Atrioventricular Valve Regurgitation in Stage 1 and Changes Across Stage 2 Surgery in Single Ventricle Patients. IEEE Trans Biomed Eng 2018; 65:2450-2458. [DOI: 10.1109/tbme.2018.2797999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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8
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Ikenaga H, Hayashi A, Nagaura T, Yamaguchi S, Yoshida J, Rader F, Siegel RJ, Kar S, Shiota T. Relation Between Pulmonary Venous Flow and Left Atrial Pressure During Percutaneous Mitral Valve Repair With the MitraClip. Am J Cardiol 2018; 122:1379-1386. [PMID: 30131107 DOI: 10.1016/j.amjcard.2018.06.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/19/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
Pulmonary venous (PV) flow may provide valuable information in terms of the severity of mitral regurgitation and left atrial (LA) pressure. We sought to find PV flow determinants of LA pressure during MitraClip procedure. We analyzed 575 PV flows in 290 patients using transesophageal echocardiography before and after MitraClip procedure. We measured peak systolic velocity (Sv), diastolic velocity (Dv), systolic velocity time integral (Svti), diastolic velocity time integral (Dvti), and those systolic to diastolic ratio as PV flow parameters. Systolic PV flow velocity was lower than diastolic PV flow velocity before the procedure, but systolic PV flow velocity markedly increased after the procedure. Peak Sv/Dv ratio and Svti/Dvti ratio after the procedure were significantly higher than those before the procedure (peak Sv/Dv; 1.06 [inter-quartile range (IQR) 0.73 to 1.34] vs 0.32 [IQR 0.03 to 0.55], p <0.001, Svti/Dvti; 1.06 [IQR 0.76 to 1.61] vs 0.26 [IQR 0.02 to 0.51], p <0.001). Peak Sv/Dv ratio and Svti/Dvti ratio were negatively correlated with mean LA pressure and LA pressure V wave, respectively (peak Sv/Dv ratio; r = -0.50 and r = -0.59, Svti/Dvti ratio; r = -0.47 and r = -0.58, p <0.001). In receiver operating characteristics curve assessing the ability of PV flow to predict mean LA pressure ≥20 mm Hg after the successful procedure, the area under the curve of peak Sv/Dv ratio was 0.76 (p <0.001). Peak Sv/Dv ratio <0.98 best predicted LA pressure ≥20 mm Hg with 77% sensitivity and 71% specificity. In conclusion, systolic PV flow velocity immediately increased in response to mitral regurgitation reduction during MitraClip procedure. PV flow velocity, specifically systolic to diastolic ratio, was useful to evaluate invasively determined LA pressure.
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Affiliation(s)
- Hiroki Ikenaga
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Atsushi Hayashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Nagaura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Satoshi Yamaguchi
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jun Yoshida
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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Kan CD, Wang JN, Lin CH, Chen WL, Lu PJ, Chan MY, Wu JT. Handmade trileaflet valve design and validation for patch-valved conduit reconstruction using generalized regression machine learning model. Technol Health Care 2018; 26:605-620. [PMID: 30040769 DOI: 10.3233/thc-171064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary valve diseases include the different degrees of aortic stenosis or congenital defects in children or adults. Valve repair or replacement surgery is commonly performed to relieve valvular dysfunction and improve the significant flow regurgitation in the aortic valve and the pulmonary valve. However, commercial valve stents and valved conduits are sometimes not available for children or patients with special conditions. The handmade trileaflet valve design has been used with different range of diameters for patch-valved conduit reconstruction. Thus, we propose a multiple regression model, as a generalized regression neural network (GRNN), to determine the optimal trileaflet parameters, including the width, length, and upper lower curved structure. Through computed tomography pulmonary angiography, while the diameter of the main pulmonary artery is determined, a leaflet template can be rapidly sketched and made. Using an experimental pulmonary circulation loop system, the efficacy of the valved conduit can be validated using the regurgitation fraction method. In contrast to commercial valve stents, experimental results indicate that the handmade trileaflet valve can also improve severe pulmonary regurgitations.
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Affiliation(s)
- Chung-Dann Kan
- Division of Cardiovascular Surgery, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital Tainan, Tainan, Taiwan
| | - Chia-Hung Lin
- Department of Electrical Engineering, Kao-Yuan University, Kaohsiung, Taiwan
| | - Wei-Ling Chen
- Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Pong-Jeu Lu
- Heart Science and Medical Devices Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Yao Chan
- Heart Science and Medical Devices Research Center, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Te Wu
- Department of Veterinary Medicine, National Chiayi University, Chiayi, Taiwan
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10
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Zhang Z, Staessen JA, Thijs L, Gu Y, Liu Y, Jacobs L, Koeck T, Zürbig P, Mischak H, Kuznetsova T. Left ventricular diastolic function in relation to the urinary proteome: a proof-of-concept study in a general population. Int J Cardiol 2014; 176:158-65. [PMID: 25065337 PMCID: PMC4155932 DOI: 10.1016/j.ijcard.2014.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/06/2014] [Accepted: 07/05/2014] [Indexed: 01/09/2023]
Abstract
Background In previous studies, we identified two urinary proteomic classifiers, termed HF1 and HF2, which discriminated subclinical diastolic left ventricular (LV) dysfunction from normal. HF1 and HF2 combine information from 85 and 671 urinary peptides, mainly up- or down-regulated collagen fragments. We sought to validate these classifiers in a population study. Methods In 745 people randomly recruited from a Flemish population (49.8 years; 51.3% women), we measured early and late diastolic peak velocities of mitral inflow (E and A) and mitral annular velocities (e' and a') by conventional and tissue Doppler echocardiography, and the urinary proteome by capillary electrophoresis coupled with mass spectrometry. Results In the analyses adjusted for sex, age, body mass index, blood pressure, heart rate, LV mass index and intake of medications, we expressed effect sizes per 1-SD increment in the classifiers. HF1 was associated with 0.204 cm/s lower e' peak velocity (95% confidence interval, 0.057–0.351; p = 0.007) and 0.145 higher E/e' ratio (0.023–0.268; p = 0.020), while HF2 was associated with a 0.174 higher E/e' ratio (0.046–0.302; p = 0.008). According to published definitions, 67 (9.0%) participants had impaired LV relaxation and 96 (12.9%) had elevated LV filling pressure. The odds of impaired relaxation associated with HF1 was 1.38 (1.01–1.88; p = 0.043) and that of increased LV filling pressure associated with HF2 was 1.38 (1.00–1.90; p = 0.052). Conclusions In a general population, the urinary proteome correlated with diastolic LV dysfunction, proving its utility for early diagnosis of this condition. Aim: to validate urinary proteomic markers for LV dysfunction in a population. Result: LV diastolic dysfunction was associated with the urinary proteome. Perspective: Screening for subclinical LV dysfunction becomes possible.
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Affiliation(s)
- Zhenyu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium; Department of Epidemiology, Maastricht University, Maastricht, Netherlands.
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Yumei Gu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Yanping Liu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Lotte Jacobs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
| | - Thomas Koeck
- Mosaiques Diagnostic and Therapeutics AG, Hannover, Germany
| | - Petra Zürbig
- Mosaiques Diagnostic and Therapeutics AG, Hannover, Germany
| | - Harald Mischak
- Mosaiques Diagnostic and Therapeutics AG, Hannover, Germany; BHF Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
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Lin WW, Fu YC, Jan SL, Wang KY, Ho HC, Lin FY, Ting CT, Chen YT. Immediate Change in Pulmonary Venous Flow Pattern after Deployment of Occluder Device for Atrial Septal Defect. Echocardiography 2009; 26:452-8. [DOI: 10.1111/j.1540-8175.2008.00835.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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12
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Paszczuk A, Wiegers SE. Quantitative assessment of mitral insufficiency: its advantages and disadvantages. Heart Fail Rev 2006; 11:205-17. [PMID: 17041761 DOI: 10.1007/s10741-006-0100-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anna Paszczuk
- Hospital of University of Pennsylvania, Pennsylvania, USA
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Abstract
The echographic methods of quantification of mitral regurgitation are various. Semiquantitative methods using the color Doppler extension of the regurgitant jet are now replaced by more quantitative methods, including PISA, jet width, and regurgitant fraction. Although sometimes difficult, accurate quantification of mitral regurgitation is now possible in a majority of patients using transthoracic echocardiography.
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Affiliation(s)
- E Abergel
- Hôpital européen Georges-Pompidou, 20-40, rue Leblanc, 75908 Paris, France.
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Yang H, Jones M, Shiota T, Qin JX, Kim YJ, Popovic ZB, Pu M, Greenberg NL, Cardon LA, Eto Y, Sitges M, Zetts AD, Thomas JD. Pulmonary venous flow determinants of left atrial pressure under different loading conditions in a chronic animal model with mitral regurgitation. J Am Soc Echocardiogr 2002; 15:1181-8. [PMID: 12411903 DOI: 10.1067/mje.2002.123959] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of our study was to quantitatively compare the changes and correlations between pulmonary venous flow variables and mean left atrial pressure (mLAP) under different loading conditions in animals with chronic mitral regurgitation (MR) and without MR. METHODS A total of 85 hemodynamic conditions were studied in 22 sheep, 12 without MR as control (NO-MR group) and 10 with MR (MR group). We obtained pulmonary venous flow systolic velocity (Sv) and diastolic velocity (Dv), Sv and Dv time integrals, their ratios (Sv/Dv and Sv/Dv time integral), mLAP, left ventricular end-diastolic pressure, and MR stroke volume. We also measured left atrial a, x, v, and y pressures and calculated the difference between v and y pressures. RESULTS Average MR stroke volume was 10.6 +/- 4.3 mL/beat. There were good correlations between Sv (r = -0.64 and r = -0.59, P <.01), Sv/Dv (r = -0.62 and r = -0.74, P <.01), and mLAP in the MR and NO-MR groups, respectively. Correlations were also observed between Dv time integral (r = 0.61 and r = 0.57, P <.01) and left ventricular end-diastolic pressure in the MR and NO-MR groups. In velocity variables, Sv (r = -0.79, P <.001) was the best predictor of mLAP in both groups. The sensitivity and specificity of Sv = 0 in predicting mLAP 15 mm Hg or greater were 86% and 85%, respectively. CONCLUSION Pulmonary venous flow variables correlated well with mLAP under altered loading conditions in the MR and NO-MR groups. They may be applied clinically as substitutes for invasively acquired indexes of mLAP to assess left atrial and left ventricular functional status.
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Affiliation(s)
- Hua Yang
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Ohio 44195, USA
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Rydén T, Bech-Hanssen O, Brandrup-Wognsen G, Nilsson F, Svensson S, Jeppsson A. The importance of grade 2 ischemic mitral regurgitation in coronary artery bypass grafting. Eur J Cardiothorac Surg 2001; 20:276-81. [PMID: 11463544 DOI: 10.1016/s1010-7940(01)00770-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To study if grade 2 ischemic mitral regurgitation (MR) influences outcome after coronary artery bypass grafting (CABG). METHODS Results of all CABG patients with grade 2/4 ischemic MR operated during 1995--1998 (n = 89) were compared with all CABG patients without MR (n = 4709) during the same period. To further evaluate patients with grade 2 ischemic MR, a case-control study focusing on functional status was performed. Control patients without MR (n = 89) were matched for age, gender and left ventricular ejection fraction. All patients were interviewed regarding angina symptoms and functional status. RESULTS Survival according to Kaplan--Meier at 1 and 3 years were inferior in the MR group compared to all CABG patients (91 vs 96% and 84 vs 92%, respectively (P = 0.0017). However, MR patients were older (68 +/- 9 vs 65 +/- 9 years (mean +/- SD), P = 0.008) and had an inferior preoperative left ventricular ejection fraction (42 +/- 14 vs 58 +/- 14%, P < 0.0001). In the case-control study, New York Heart Association (NYHA) class and Higgins' risk score differed preoperatively between the MR group and controls. Neither 30-day mortality (4,5% in both groups) nor survival at 1 (91 vs 93%) and 3 years (84 vs 88%) differed significantly. NYHA class and angina class (Canadian Cardiovascular Society, CCS) improved similarly in both groups. Postoperatively, 62% of the patients in the MR group had reduced, 36% unchanged and 2% increased MR. CONCLUSIONS CABG on patients with grade 2 ischemic MR reduces angina pectoris and improves functional status to the same extent as in CABG patients without MR. Postoperative morbidity and mortality do not differ significantly between the groups. Grade of MR is reduced or unchanged after CABG in patients with grade 2 ischemic MR. The study supports an operative strategy where grade 2 ischemic mitral regurgitation is treated by CABG alone but the result do not exclude that there might be individual patients that would benefit from a valvular or annular procedure in combination with CABG. How these patients should be identified remains unclear.
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Affiliation(s)
- T Rydén
- Department of Cardiothoracic Surgery Sahlgrenska University Hospital, Göteborg, Sweden
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de Marchi SF, Bodenmüller M, Lai DL, Seiler C. Pulmonary venous flow velocity patterns in 404 individuals without cardiovascular disease. Heart 2001; 85:23-9. [PMID: 11119456 PMCID: PMC1729579 DOI: 10.1136/heart.85.1.23] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the pulmonary venous flow velocity (PVFV) values in a large normal population. DESIGN Prospective study in consecutive individuals. SETTING University hospital. METHODS Among 404 normal individuals, the flow velocity pattern in the right upper pulmonary vein was recorded in 315 subjects using transthoracic echocardiography, and in both upper pulmonary veins in 100 subjects using transoesophageal echocardiography. Subjects were divided into five age groups. The PVFV values were compared between transthoracic and transoesophageal echocardiography within the age groups, and intraindividually between the right and left upper pulmonary veins in transoesophageal echocardiography. RESULTS Normal PVFV values for the right upper pulmonary vein in transthoracic and transoesophageal echocardiography are presented. The duration of flow reversal at atrial contraction was overestimated using transthoracic echocardiography (mean (SD): 96 (21) ms in transoesophageal echocardiography, 120 (28) ms in transthoracic echocardiography, p < 0.0001). Systolic to diastolic peak flow velocity ratio (S:D) increased earlier with advancing age with transoesophageal echocardiography than with transthoracic echocardiography. Similar results were found for the corresponding time-velocity integrals. Data from the left and right upper pulmonary veins differed with respect to onset and deceleration of flow velocities, but not for flow durations or peak velocities. CONCLUSIONS Normal PVFV values generally show a wide range. The data presented will be of value in assessing left ventricular diastolic function and mitral regurgitation using the PVFV pattern.
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Affiliation(s)
- S F de Marchi
- Swiss Cardiovascular Centre Bern, Cardiology, University Hospital, Freiburgstrasse, CH-3010 Bern, Switzerland.
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Doppler echocardiographic assessment of diastolic ventricular function: transmitral and pulmonary venous flow indices. PROGRESS IN PEDIATRIC CARDIOLOGY 1999. [DOI: 10.1016/s1058-9813(99)00023-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pu M, Griffin BP, Vandervoort PM, Stewart WJ, Fan X, Cosgrove DM, Thomas JD. The value of assessing pulmonary venous flow velocity for predicting severity of mitral regurgitation: A quantitative assessment integrating left ventricular function. J Am Soc Echocardiogr 1999; 12:736-43. [PMID: 10477418 DOI: 10.1016/s0894-7317(99)70024-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Although alteration in pulmonary venous flow has been reported to relate to mitral regurgitant severity, it is also known to vary with left ventricular (LV) systolic and diastolic dysfunction. There are few data relating pulmonary venous flow to quantitative indexes of mitral regurgitation (MR). The object of this study was to assess quantitatively the accuracy of pulmonary venous flow for predicting MR severity by using transesophageal echocardiographic measurement in patients with variable LV dysfunction. This study consisted of 73 patients undergoing heart surgery with mild to severe MR. Regurgitant orifice area (ROA), regurgitant stroke volume (RSV), and regurgitant fraction (RF) were obtained by quantitative transesophageal echocardiography and proximal isovelocity surface area. Both left and right upper pulmonary venous flow velocities were recorded and their patterns classified by the ratio of systolic to diastolic velocity: normal (>/=1), blunted (<1), and systolic reversal (<0). Twenty-three percent of patients had discordant patterns between the left and right veins. When the most abnormal patterns either in the left or right vein were used for analysis, the ratio of peak systolic to diastolic flow velocity was negatively correlated with ROA (r = -0.74, P <.001), RSV (r = -0.70, P <.001), and RF (r = -0.66, P <.001) calculated by the Doppler thermodilution method; values were r = -0.70, r = -0.67, and r = -0.57, respectively (all P <.001), for indexes calculated by the proximal isovelocity surface area method. The sensitivity, specificity, and predictive values of the reversed pulmonary venous flow pattern for detecting a large ROA (>0.3 cm(2)) were 69%, 98%, and 97%, respectively. The sensitivity, specificity, and predictive values of the normal pulmonary venous flow pattern for detecting a small ROA (<0.3 cm(2)) were 60%, 96%, and 94%, respectively. However, the blunted pattern had low sensitivity (22%), specificity (61%), and predictive values (30%) for detecting ROA of greater than 0.3 cm(2) with significant overlap with the reversed and normal patterns. Among patients with the blunted pattern, the correlation between the systolic to diastolic velocity ratio was worse in those with LV dysfunction (ejection fraction <50%, r = 0.23, P >.05) than in those with normal LV function (r = -0.57, P <.05). Stepwise linear regression analysis showed that the peak systolic to diastolic velocity ratio was independently correlated with RF (P <.001) and effective stroke volume (P <.01), with a multiple correlation coefficient of 0.71 (P <.001). In conclusion, reversed pulmonary venous flow in systole is a highly specific and reliable marker of moderately severe or severe MR with an ROA greater than 0.3 cm(2), whereas the normal pattern accurately predicts mild to moderate MR. Blunted pulmonary venous flow can be seen in all grades of MR with low predictive value for severity of MR, especially in the presence of LV dysfunction. The blunted pulmonary venous flow pattern must therefore be interpreted cautiously in clinical practice as a marker for severity of MR.
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Affiliation(s)
- M Pu
- Cardiovascular Imaging Center , The Cleveland Clinic Foundation, OH 44195-5064, USA
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