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Ladányi Z, Eltayeb A, Fábián A, Ujvári A, Tolvaj M, Tokodi M, Choudhary KA, Kovács A, Merkely B, Vriz O, Lakatos BK. The effects of mitral stenosis on right ventricular mechanics assessed by three-dimensional echocardiography. Sci Rep 2024; 14:17112. [PMID: 39048660 PMCID: PMC11269591 DOI: 10.1038/s41598-024-68126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p < 0.001), global circumferential (GCS) (- 21.08 ± 5.64% vs. - 25.07 ± 4.72%; p = 0.001) and longitudinal strain (GLS) (- 16.60% ± 4.07% vs. - 23.32 ± 2.82%; p < 0.001) were reduced. When comparing RV contraction patterns between controls, MS patients in sinus rhythm and those with atrial fibrillation, radial (REF) (32.06 ± 5.33% vs. 23.62 ± 7.95% vs. 20.89 ± 6.92%; p < 0.001) and longitudinal ejection fraction (LEF) (24.85 ± 4.06%; 17.82 ± 6.16% vs. 15.91 ± 4.09%; p < 0.001) were decreased in both MS groups compared to controls; however, they were comparable between the two MS subgroups. Anteroposterior ejection fraction (AEF) (29.16 ± 4.60% vs. 30.87 ± 7.71% vs. 21.48 ± 6.15%; p < 0.001) showed no difference between controls and MS patients in sinus rhythm, while it was lower in the MS group with atrial fibrillation. Therefore, utilizing 3D echocardiography, we found distinct morphological and functional alterations of the RV in MS patients.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary.
| | - Abdalla Eltayeb
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Olga Vriz
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
- Ospedale Sant'Antonio, San Daniele del Friuli, Italy
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
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Bigdelu L, Alimi H, Poorzand H, Ghaderi F, Afshar S, Rafighdoost AH, Baradaran Rahimi V. Relationship between New York functional class and duke activity status index with the severity of mitral valve stenosis and echocardiographic parameters: is left atrial strain a better predictor? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1115-1122. [PMID: 38589678 DOI: 10.1007/s10554-024-03082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 03/09/2024] [Indexed: 04/10/2024]
Abstract
Purpose This study aimed to investigate the relationship between symptoms of patients with severe mitral stenosis (MS), evaluated by the New York Heart Association (NYHA) functional class and Duke Activity Status Index (DASI) score, and echocardiographic parameters. We evaluated patients with severe rheumatic MS diagnosed as mitral valve area (MVA) less than 1.5 cm2. All patients underwent transthoracic echocardiography and the left atrium (LA) reservoir auto-strain (LASr) analysis. In addition, DASI and NYHA scores were determined to evaluate the functional capacity and symptoms of MS patients. We evaluated 60 patients with MS with a mean age of 50.13 ± 10.28 and a median DASI score of 26.95 (26.38). There were 6 (10%) and 28 (46.7%) patients with NYHA class I and II, and 25 (40.0%) and 2 (3.3%) patients with NYHA class III and IV, respectively. NYHA class was positively correlated with LA area (LAA, r = 0.638), LA volume (LAV, r = 0.652), LAV index (LAVI, r = 0.62), E (r = 0.45), A (r = 0.25), and pulmonary artery pressure (PAP, r = 0.34), while negatively correlated with LASr (r = - 0.73) and MVA (r = - 0.417). Furthermore, the DASI score was positively associated with LASr (r = 0.81) and MVA (r = 0.52) while negatively correlated with LAA (r = - 0.62), LAV (r = - 0.65), LAVI (r = - 0.56), E (r = - 0.46), A (r = - 0.3), and PAP (r = - 0.32). Our findings indicate that LAA, LAV, LAVI, E, A, PAP, MVA, and LASr are associated with NYHA and DASI scores in MS patients. Additionally, the LASr had the strongest correlation between all measured parameters in severe MS patients.
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Affiliation(s)
- Leila Bigdelu
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fereshteh Ghaderi
- Vascular and Endovascular Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Afshar
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hossein Rafighdoost
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vafa Baradaran Rahimi
- Department of Cardiovascular Diseases, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
- Pharmacological Research Center of Medicinal Plants, Mashhad University of Medical Sciences, Mashhad, Iran.
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Mehrabi-Pari S, Nayebirad S, Shafiee A, Vakili-Basir A, Hali R, Ghavami M, Jalali A. Segmental and global longitudinal strain measurement by 2-dimensional speckle tracking echocardiography in severe rheumatic mitral stenosis. BMC Cardiovasc Disord 2023; 23:584. [PMID: 38012599 PMCID: PMC10683114 DOI: 10.1186/s12872-023-03624-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The present study aimed to detect subtle left ventricular (LV) dysfunction in patients with severe rheumatic mitral stenosis (MS) by measuring global and segmental longitudinal strain with a two-dimensional speckle tracking echocardiography (2D-STE) method. METHODS In this case-control study, 65 patients with severe rheumatic MS and preserved ejection fraction (EF ≥ 50% measured by conventional echocardiographic methods) were compared with 31 otherwise healthy control subjects. All patients underwent LV strain measurement by the 2D-STE method in addition to conventional echocardiography using a VIVID S60 echocardiography device. RESULTS Absolute strain values in myocardial segments 1-8, 10, and 12 (all basal, mid anterior, mid anteroseptal, mid inferior, and mid anterolateral segments) were significantly lower in patients with severe MS compared with the control group (P < 0.05 for all). The absolute global longitudinal strain (GLS) value was higher in the control group (-19.56 vs. -18.25; P = 0.006). After adjustment for age, gender, and systolic blood pressure, the difference in GLS between the two groups was as follows: mean difference=-1.16; 95% CI: -2.58-0.25; P = 0.110. CONCLUSION In patients with severe rheumatic MS and preserved EF, the absolute GLS tended to be lower than healthy controls. Furthermore, the segmental strain values of LV were significantly lower in most of the basal and some mid-myocardial segments. Further studies are warranted to investigate the underlying pathophysiology and clinical implications of this subclinical dysfunction in certain segments of patients with severe rheumatic MS.
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Affiliation(s)
- Samira Mehrabi-Pari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepehr Nayebirad
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Shafiee
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Vakili-Basir
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Hali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Echocardiography, Tehran Heart Center, North Karegar st, Tehran, 1411713138, Iran.
| | - Mojgan Ghavami
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Putra TMH, Rodriguez-Fernandez R, Widodo WA, Elfiana M, Laksono S, Nguyen QN, Tan JWC, Narula J. Myocardial fibrosis in rheumatic heart disease: emerging concepts and clinical implications. Front Cardiovasc Med 2023; 10:1230894. [PMID: 37564912 PMCID: PMC10411611 DOI: 10.3389/fcvm.2023.1230894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Rheumatic heart disease (RHD) remains a significant cardiovascular burden in the world even though it is no longer common in affluent countries. Centuries of history surrounding this disease provide us with a thorough understanding of its pathophysiology. Infections in the throat, skin, or mucosa are the gateway for Group A Streptococcus (GAS) to penetrate our immune system. A significant inflammatory response to the heart is caused by an immunologic cascade triggered by GAS antigen cross-reactivity. This exaggerated immune response is primarily responsible for cardiac dysfunction. Recurrent inflammatory processes damage all layers of the heart, including the endocardium, myocardium, and pericardium. A vicious immunological cycle involving inflammatory mediators, angiotensin II, and TGF-β promotes extracellular matrix remodeling, resulting in myocardial fibrosis. Myocardial fibrosis appears to be a prevalent occurrence in patients with RHD. The presence of myocardial fibrosis, which causes left ventricular dysfunction in RHD, might be utilized to determine options for treatment and might also be used to predict the outcome of interventions in patients with RHD. This emerging concept of myocardial fibrosis needs to be explored comprehensively in order to be optimally utilized in the treatment of RHD.
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Affiliation(s)
| | | | - Wishnu Aditya Widodo
- Department of Cardiology and Vascular Medicine, Jakarta Heart Center, Jakarta, Indonesia
| | - Maria Elfiana
- Research Unit, Jakarta Heart Center, Jakarta, Indonesia
| | - Sidhi Laksono
- Faculty of Medicine, Universitas Muhammadiyah Prof. DR. Hamka, Tangerang, Indonesia
| | | | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Zhang S, Liu C, Zhang Y, Wu Z, Feng K, Lai Y, Pei J, Guan T. Different heart failure phenotypes of valvular heart disease: the role of mitochondrial dysfunction. Front Cardiovasc Med 2023; 10:1135938. [PMID: 37273869 PMCID: PMC10235483 DOI: 10.3389/fcvm.2023.1135938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
Valvular heart disease (VHD)-related heart failure (HF) is a special subtype of HF with an increasingly concerned heterogeneity in pathophysiology, clinical phenotypes, and outcomes. The mechanism of VHD-related HF involves not only mechanical damage to the valve itself but also valve lesions caused by myocardial ischemia. The interactions between them will lead to the occurrence and development of VHD-related HF subtypes. Due to the spatial (combination of different valvular lesions) and temporal effects (sequence of valvular lesions) of valvular damages, it can make the patient's condition more complicated and also make the physicians deal with a dilemma when deciding on a treatment plan. This indicates that there is still lack of deep understanding on the pathogenic mechanism of VHD-related HF subtypes. On the other hand, mitochondrial dysfunction (MitD) is not only associated with the development of numerous cardiac diseases such as atherosclerosis, hypertension, diabetes, and HF but also occurs in VHD. However, the role of MitD in VHD-related HF is still not fully recognized. In this comprehensive review, we aim to discuss the current findings and challenges of different valvular damages derived from HF subtypes as well as the role of MitD in VHD-related HF subtypes.
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Affiliation(s)
- Shenghui Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Cheng Liu
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yingyuan Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zongjian Wu
- City School, Guangzhou Academy of Fine Arts, Guangzhou, China
| | - Kaiwei Feng
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanxian Lai
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jingxian Pei
- Department of Cardiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianwang Guan
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Singh G, Prajapati J, Parhikh R, Sharma K, Patel I, Mishra A, Singh L, Patel U, Vadodariyai J. Effect of percutaneous balloon mitral valvuloplasty on left ventricular function in rheumatic mitral stenosis. HEART, VESSELS AND TRANSPLANTATION 2022. [DOI: 10.24969/hvt.2022.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roslan A, Aris FA, Sin TY, Ashari A, Shaparudin AA, Shah WFWR, Jhung LT, Beng KH, Aktifanus ATJ, Nuruddin AA. Comprehensive echocardiographic and speckle tracking strain analysis in rheumatic mitral stenosis patients before and after transvenous mitral commissurotomy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1307-1316. [PMID: 34978670 DOI: 10.1007/s10554-021-02518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the first line treatment for rheumatic mitral stenosis (MS). We sought to evaluate (1) changes in 2-dimensional (2D) echocardiographic and strain values and (2) differences in these values for patients in atrial fibrillation (AF) and sinus rhythm (SR) pre, immediately and 6 months post PTMC. Retrospective study of 136 patients who underwent PTMC between 2011 and 2021. We analyzed their 2D echocardiogram, Global Longitudinal Strain (GLS), Left Atrial Reservoir Strain (LAr-S) and Right Ventricle Free Wall Strain (RVFW-S) pre, immediately and 6 months post PTMC. At 6 months, mitral valve area increases from 0.94 ± 0.23 cm2 to 1.50 ± 0.42 cm2. Ejection fraction (EF) did not change post PTMC (pre; 55.56 ± 6.62%, immediate; 56.68 ± 7.83%, 6 months; 56.28 ± 7.00%, p = 0.218). Even though EF is preserved, GLS is lower pre-procedure; - 11.52 ± 3.74% with significant improvement at 6 months; - 15.16 ± 4.28% (p < 0.001). Tricuspid annular plane systolic excursion (TAPSE) improved at 6 months from 1.95 ± 0.43 to 2.11 ± 0.49 (p = 0.004). RVFW-S increases at 6 months from - 17.37 ± 6.03% to - 19.75 ± 7.19% (p = 0.011). LAr-S improved from 11.23 ± 6.83% pre PTMC to 16.80 ± 8.82% at 6 months (p < 0.001) post PTMC. Pre-procedure patients with AF have lower strain values (More LV, RV and LA dysfunction) with statistically significant difference for LAr-S (p < 0.001), GLS (p < 0.001) and RVFW-S (p < 0.001) than patients in SR. Patients with severe rheumatic MS have subclinical left and right ventricle dysfunction despite preserved EF and relatively normal TAPSE with significant improvement seen at 6 months post PTMC. AF patients have lower baseline strain values than SR patients.
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Affiliation(s)
- Aslannif Roslan
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
| | - Faten A Aris
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Tey Yee Sin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Afif Ashari
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Abdul A Shaparudin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Wan Faizal W Rahimi Shah
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Lee Tjen Jhung
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Koh Hui Beng
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | | | - Amin Ariff Nuruddin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
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Ferreira MVS, Cunha CRD, Oliveira GS, Otto ME, Atik FA. Left Ventricular Remodeling Shortly after Open Mitral Valve Replacement for Rheumatic Mitral Stenosis. Braz J Cardiovasc Surg 2021; 36:468-475. [PMID: 34617428 PMCID: PMC8522327 DOI: 10.21470/1678-9741-2020-0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Left ventricular dysfunction after surgical treatment of mitral stenosis is
uncommon. We intend to determine the pattern of left ventricular remodeling,
shortly after open mitral valve replacement for rheumatic mitral stenosis,
with in-hospital postoperative outcomes and the determinants of
postoperative worsening of left ventricular ejection fraction. Methods From January 2008 to January 2015, 107 adult patients with rheumatic mitral
stenosis were submitted to open mitral valve replacement. Their mean age was
45±11 years and 93 (86.9%) were women. Left ventricular morphology
and function were studied longitudinally with echocardiography. The end
point was postoperative worsening of left ventricular ejection fraction,
defined by a decrease of 10% compared to preoperative basal assessment.
Determinants of worsening left ventricular ejection fraction were determined
by multivariable logistic regression analysis. Results The end point occurred in 18 patients (16.8%). We tested clinical and
echocardiographic parameters to verify independent variables related to the
decrease in postoperative ejection fraction. Lower body weight
(P=0.005; odds ratio [OR]=0.89) and smaller
preoperative mitral valve area (P=0.02; OR=0.02) were
independent predictors of left ventricular dysfunction. These patients
presented higher mortality and morbidity rates. Conclusion Left ventricular remodeling patterns differed among patients with
predominant rheumatic mitral stenosis undergoing open mitral valve
replacement. Lower preoperative body weight and mitral valve area were
independent determinants of deteriorating ejection fraction with increased
end-systolic volumes, indicating that this specific problem may occur in
anthropometric smaller patients with more extensive rheumatic disease.
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Affiliation(s)
| | - Cláudio Ribeiro da Cunha
- Department of Echocardiography, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil
| | - Gabrielle Santos Oliveira
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil
| | - Maria Estefânia Otto
- Department of Echocardiography, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil
| | - Fernando Antibas Atik
- Department of Cardiovascular Surgery, Instituto de Cardiologia do Distrito Federal, Brasília, DF, Brazil
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Advances in Rheumatic Mitral Stenosis: Echocardiographic, Pathophysiologic, and Hemodynamic Considerations. J Am Soc Echocardiogr 2021; 34:709-722.e1. [PMID: 33652082 DOI: 10.1016/j.echo.2021.02.015] [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: 10/20/2020] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/23/2022]
Abstract
Echocardiography is the primary imaging modality used in patients with mitral stenosis. Doppler-derived measurements of mitral pressure half-time are commonly used to calculate mitral valve area, but a number of hemodynamic confounders associated with advanced age limit its utility. Planimetry remains the gold standard for determining mitral valve area and may be performed using two- or three-dimensional imaging. Although the Wilkins score has been used for >30 years to predict balloon mitral valvuloplasty outcomes, newer scoring systems have been proposed to improve predictive accuracy. Some patients undergoing technically successful balloon mitral valvuloplasty may not have satisfactory clinical outcomes. These individuals may be identified by the presence of reduced net atrioventricular compliance, which can be measured echocardiographically. Exercise testing may be useful in patients with mitral stenosis whose symptomatic status is incongruous their mitral valve area. Last, reduced left atrial systolic strain, an indicator of poor left atrial compliance, has been shown to reliably predict adverse outcomes in patients with mitral stenosis. The author discusses the hemodynamics and path ophysiology of mitral stenosis and reviews current and emerging roles of echocardiography in its evaluation.
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Nader V, Matta A, Canitrot R, Itier R, Salameh P, Lairez O, Elbaz M, Galinier M, Azar R, Roncalli J. Evaluation of Mitral and Aortic Valvular Disease and Left Ventricular Dysfunction in a Lebanese Population: Retrospective Single-Center Experience. Med Sci Monit 2021; 27:e928218. [PMID: 33558450 PMCID: PMC7883403 DOI: 10.12659/msm.928218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Recently, new therapeutic approaches have revolutionized the management of left ventricular dysfunction (LVD) and valvular heart disease (VHD), which are a growing public health problem. In parallel, there are no available epidemiological data about LVD and VHD in developing countries, especially in the Mediterranean area. This retrospective study was conducted at a single center and aimed to evaluate the associations between mitral and aortic valvular disease and left ventricle systolic and diastolic dysfunction in the Lebanese population. MATERIAL AND METHODS A retrospective study was conducted of 4520 consecutive patients aged >18 years who were referred to the Cardiovascular Department of Notre Dame de Secours-University Hospital in Jbeil-Lebanon for transthoracic echocardiography between December 2016 and December 2019. The study population was divided into different groups based on types of LVD and VHD. Left ventricle systolic dysfunction was defined as a left ventricle ejection fraction (EF) ≤40%. Statistical analysis was carried out using SPSS software version 20. RESULTS VHD and systolic dysfunction were more common in men, whereas diastolic dysfunction was more common in women. Being older than age 65 years and smoking were significantly associated with heart failure with preserved EF, whereas female sex was a significant preventive factor against heart failure with reduced EF. Systemic hypertension was correlated with mitral stenosis and tricuspid regurgitation, whereas diabetes mellitus was associated with tricuspid regurgitation (TR). Smoking and older age also appeared to be associated with aortic stenosis. CONCLUSIONS Mitral valve disease (regurgitation and stenosis) was significantly correlated with systolic dysfunction, whereas aortic and mitral regurgitation were associated with diastolic dysfunction. Better monitoring of cardiovascular disease risk factors may lead to a reduced burden of LVD and VHD.
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Affiliation(s)
- Vanessa Nader
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.,Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Anthony Matta
- Department of Cardiology, Toulouse University Hospital, Toulouse, France.,Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon
| | - Ronan Canitrot
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Romain Itier
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | | | - Olivier Lairez
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Rania Azar
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
| | - Jerome Roncalli
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
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Seçkin Göbüt Ö, Ünlü S, Taçoy G. Evaluation of left and right ventricular functions with three-dimensional speckle tracking in patients with mitral stenosis. Echocardiography 2021; 38:289-295. [PMID: 33492741 DOI: 10.1111/echo.14982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/01/2020] [Accepted: 01/08/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The function of both ventricles has been suggested to be affected in patients with mitral stenosis. In this study, it was aimed to investigate deformation properties of right (RV) and left ventricle (LV) in rheumatic mitral stenosis (MS) patients with three-dimensional speckle tracking echocardiography (3D-STE). METHODS A total of 60 patients were included in the study (20 patients with mild MS diagnosis, 20 patients with moderate MS diagnosis, and 20 healthy volunteers). Three-dimensional echocardiography datasets were obtained for both ventricles in all patients. LV global longitudinal strain (GLS), LV torsion, RV free wall (FW) LS, and interventricular septal (IVS) LS measurements were analyzed. RESULTS The LV ejection fraction (EF), RV fractional area change, peak systolic velocity of the tricuspit annulus, isovolumic acceleration, and tricuspid annular plane systolic excursion values were statistically similar and in the normal range. The LV GLS measurements were significantly different among the groups by being highest in the control group and least in the moderate stenosis group. Patients with MS showed higher torsional values, correlated with MS severity. IVS LS, RVFW LS values obtained by RV analysis also differed significantly among groups. The RVFW-GLS values only showed significant difference between the control group and moderate MS group. CONCLUSION Patients with MS showed lower LV-GLS and higher LV torsion values. RV deformation indices showed significant decrease in correlation with the severity of the mitral stenosis. In conclusion, our data suggest that subclinical LV and RV systolic dysfunction is present in mild-moderate MS patients and this dysfunction can be detected by 3D-STE.
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Affiliation(s)
- Özden Seçkin Göbüt
- Cardiology Department, Dr Abdurrahman Yurtaslan Oncology Education and Research Hospital, Ankara, Turkey.,Cardiology Department, Gazi University, Ankara, Turkey
| | - Serkan Ünlü
- Cardiology Department, Gazi University, Ankara, Turkey
| | - Gülten Taçoy
- Cardiology Department, Gazi University, Ankara, Turkey
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Mahajan S, Mehra P, Mehta V, Yusuf J, Safal, Gupta A, Kathuria S, Mukhopadhyay S. Left and right ventricular deformation in patients with severe mitral stenosis and pulmonary hypertension undergoing percutaneous balloon mitral valvuloplasty: A two dimensional speckle-tracking echocardiographic study. Indian Heart J 2020; 72:614-618. [PMID: 33357656 PMCID: PMC7772604 DOI: 10.1016/j.ihj.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/19/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
Seventy-five patients with isolated severe MS (mitral valve area: 1.10 ± 0.15 cm2) and pulmonary hypertension underwent regional and global longitudinal strain (GLS) measurements of left (LV) and right ventricle (RV) at baseline and within 48 h after percutaneous balloon mitral valvuloplasty (PBMV). PBMV resulted in significant improvement in LV GLS (−16.35 ± 1.67% vs −19.98 ± 2.17%) and RV GLS (−10.34 ± 2.38% vs −13.83 ± 2.04%), p < 0.001 for both. Absolute increase in strain of basal segments of LV was more compared to mid and apical segments. We also found significant positive correlation between decrease in mean LA pressure (pre PBMV 28.91 ± 4.21 mm Hg vs post PBMV 10.55 ± 3.04 mm Hg, difference of 16.36 mm Hg; p < 0.001) obtained invasively during PBMV for 62 patients with improvement in LV GLS (r = 0.257, p = 0.048), RV GLS (r = 0.267, p = 0.043), and fall in right ventricular systolic pressure (r = 0.308, p = 0.022) that occurred post PBMV. The LV dysfunction is predominantly because of altered hemodynamics due to restricted LV filling with additional contribution from rheumatic involvement of basal LV myocardial segments. The improvement in LV deformation after PBMV is likely due to increase in preload. RV afterload reduction because of LA pressure decrease improved RV deformation.
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Affiliation(s)
- Sudhanshu Mahajan
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Pratishtha Mehra
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Vimal Mehta
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India.
| | - Jamal Yusuf
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Safal
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Abhishek Gupta
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Sanjeev Kathuria
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
| | - Saibal Mukhopadhyay
- Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical Education & Research, New Delhi, 110002, India
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Poyraz E, Kemaloglu Oz T, Çetin Güvenç R, Guvenc TS. Correlation and agreement between 2D and 3D speckle-tracking echocardiography for left ventricular volumetric, strain, and rotational parameters in healthy volunteers and in patients with mild mitral stenosis. Echocardiography 2019; 36:897-904. [PMID: 31002179 DOI: 10.1111/echo.14336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/18/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Recent advances had allowed measurement of myocardial deformation parameters using 3D speckle-tracking echocardiography (STE). Agreement between these two modalities and interchangeability of findings remain as an issue since 2DSTE is more widely available than 3DSTE. The aim of this study was to investigate the correlation and agreement between 2DSTE and 3DSTE in healthy volunteers and in patients with mild mitral stenosis (MS). METHODS Data from 31 patients with mild MS and 27 healthy volunteers were included in this study. Data were analyzed for the correlation and agreement between 2DSTE and 3DSTE for volumetric, strain, and rotational parameters. RESULTS There were no significant differences between 2DSTE and 3DSTE in both control and MS groups for left ventricular volumetric and rotational parameters. 3D global longitudinal strain (GLS) and global circumferential strain (GCS) were significantly higher in healthy volunteers (P < 0.001 for both), while only 3DGCS was significantly higher than 2DGCS in MS group (P < 0.001). The correlation between 3DSTE and 2DSTE was weak-to-moderate in both groups for strain and rotational parameters, and overall, correlation coefficients were higher in MS group. An exception was GLS in MS group, where coefficient of correlation was excellent (r = 0.907). Agreement between two modalities was poor for strain and rotational parameters, and the average bias was high. CONCLUSIONS Overall, the agreement between 2DSTE and 3DSTE for strain and rotational measures was poor with a high average bias. The agreement between 2DSTE and 3DSTE is affected by the presence of underlying MS and the direction of strain.
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Affiliation(s)
- Esra Poyraz
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Tugba Kemaloglu Oz
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | | | - Tolga Sinan Guvenc
- Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey.,Division of Cardiology, University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
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Vijay S, Tiwari B, Mehta P, Misra M. The assessment of left/right ventricular strain and deformation in patients with severe rheumatic mitral stenosis before and after balloon mitral valvuloplasty using speckle tracking echocardiography. HEART INDIA 2019. [DOI: 10.4103/heartindia.heartindia_37_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Soesanto AM, Desandri DR, Haykal TM, Kasim M. Association between late gadolinium enhancement and global longitudinal strain in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 2018; 35:781-789. [PMID: 30556113 DOI: 10.1007/s10554-018-1511-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/01/2018] [Indexed: 11/26/2022]
Abstract
The correlation between the extent of myocardial fibrosis and subclinical left ventricle (LV) systolic dysfunction in rheumatic mitral stenosis (MS) has not been widely studied. We sought to evaluate the correlation between the extent of LV myocardial fibrosis quantified by late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) and global longitudinal strain (GLS) by speckle tracking echocardiography (STE) in patients with rheumatic MS. We prospectively evaluated 36 consecutive rheumatic MS patients who were planning to undergo mitral valve surgery. Then we evaluate the correlation between the extent of LV myocardial fibrosis quantified by LGE CMR and the systolic LV function by GLS using STE. Thirty-six patients with mean age of 45.7 ± 9.9 years old, showed mean LGE was 4.9 ± 2.7%. The mean LV ejection fraction (EF) measured by CMR was 50 ± 10.8%, and the mean LV GLS was 13.5 ± 3.9%. There was a moderate correlation between GLS and LGE (r - 0.432, p = 0.009). There were no correlations between GLS with mitral valve area (MVA) with r 0.149, p = 0.385, mean mitral valve gradient (MVG) with r -0.078, p = 0.653, and LVEF (r 0.299, p = 0.076). There was a moderate correlation between LGE and GLS in patients with rheumatic MS.
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Affiliation(s)
- Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Dwita Rian Desandri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Teuku Muhammad Haykal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Manoefris Kasim
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Esteves WAM, Lodi-Junqueira L, Soares JR, Sant'Anna Athayde GR, Goebel GA, Carvalho LA, Zeng X, Hung J, Tan TC, Nunes MCP. Impact of percutaneous mitral valvuloplasty on left ventricular function in patients with mitral stenosis assessed by 3D echocardiography. Int J Cardiol 2017; 248:280-285. [PMID: 28712559 DOI: 10.1016/j.ijcard.2017.06.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/26/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The status of intrinsic left ventricular (LV) contractility in patients with isolated rheumatic mitral stenosis (MS) has been debated. The acute changes in loading conditions after percutaneous mitral valvuloplasty (PMV) may affect LV performance. We aimed to examine the acute effects of PMV on LV function and identify factors associated with LV ejection fraction (LVEF) changes, and determinants of long-term events following the procedure. METHODS One hundred and forty-two patients who underwent PMV for symptomatic rheumatic MS (valve area of 0.99±0.3cm2) were prospectively enrolled. LV volumes and LVEF were measured by three-dimensional (3D) echocardiography. Long-term outcome was a composite endpoint of death, mitral valve (MV) replacement, repeat PMV, new onset of atrial fibrillation, and stroke. RESULTS The mean age was 42.3±12.1years, and 125 patients were women (88%). After PMV, LVEF increased significantly (51.4 vs 56.5%, p<0.001), primary due to a significant increase in LV end-diastolic volume (65.8mL vs 67.9mL, p=0.002), and resultant increase in the stroke volume (33.9mL vs 39.6mL, p<0.001). Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. During a mean follow-up period of 30.8months, 28 adverse clinical events were observed. Postprocedural mitral regurgitation, MV area, and mean gradient were independent predictors of composite endpoints. CONCLUSIONS In patients with rheumatic MS, PMV resulted in a significant improvement in LV end-diastolic volume, stroke volume and consequently increased in LVEF. Changes in cardiac index and systolic pulmonary artery pressure were associated with LVEF changes after PMV. The predictors of long-term adverse events following PMV were post-procedural variables, including mitral regurgitation, valve area, and mean gradient.
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Affiliation(s)
- William Antonio M Esteves
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Lodi-Junqueira
- School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Juliana Rodrigues Soares
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Guilherme Rafael Sant'Anna Athayde
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Gabriela Assunção Goebel
- School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Lucas Amorim Carvalho
- School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Xin Zeng
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Timothy C Tan
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Carmo Pereira Nunes
- Post-Graduate Program in Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; School of Medicine and Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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17
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Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study. Int J Cardiovasc Imaging 2017; 33:1323-1330. [DOI: 10.1007/s10554-017-1109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
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18
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Barros-Gomes S, Eleid MF, Dahl JS, Pislaru C, Nishimura RA, Pellikka PA, Pislaru SV. Predicting outcomes after percutaneous mitral balloon valvotomy: the impact of left ventricular strain imaging. Eur Heart J Cardiovasc Imaging 2016; 18:763-771. [DOI: 10.1093/ehjci/jew160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 07/06/2016] [Indexed: 01/19/2023] Open
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Rifaie O, Abdel-Rahman MA, Samir S, Malik KZ, Omar AMS. Worsening of left ventricular twist mechanics in isolated rheumatic mitral stenosis immediately after balloon mitral valvuloplasty. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Use of strain and strain rate echocardiographic imaging to predict the progression of mitral stenosis: a 5-year follow-up study the progression of mitral stenosis: a 5-year follow-up study. Anatol J Cardiol 2016; 16:772-777. [PMID: 27182618 PMCID: PMC5324938 DOI: 10.14744/anatoljcardiol.2015.6590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Little information is available about echocardiographic progression of mitral stenosis (MS). The aim of this study was to investigate whether the left ventricular (LV) strain is a favorable method predicting the progression of MS. Methods: Forty-eight patients with isolated mild-to-moderate MS were enrolled in this prospective cohort study. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured by two-dimensional echocardiography (2-DE) at the baseline. Mitral valve area (MVA) was evaluated during the 5-year follow-up. The change in MVA from the beginning to the end of the surveillance period was determined as an indicator of progression. Pearson’s correlation test was used, and significant differences between the groups were analyzed using the Student’s t-test or the Mann–Whitney U test. At the end of follow-up, we evaluated the correlation between the change in MVA and both GLS-GLSR. GLS and GLSR are predictive factors for MS progression, whether or not it has been tested according to the receiver operating characteristics curve analysis. Results: A meaningful correlation was detected between the change in MVA with both GLS and GLSR (r=0.924 and r=0.980, respectively, p<0.001). The cut-off value for GLS was identified as –16.98 (sensitivity 81%, specificity 96%, p<0.001) and for GLSR as –1.45 (sensitivity 95%, specificity 100%, p<0.001). Patients with MS having a value under (mathematically above) these cut-off values showed more rapid progression. Conclusion: The progression of MS can be predicted by GLS and GLSR measurements, which are evaluated via strain echocardiography. (Anatol J Cardiol 2016; 16: 772-7)
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Younan H. Role of two dimensional strain and strain rate imaging in assessment of left ventricular systolic function in patients with rheumatic mitral stenosis and normal ejection fraction. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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22
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Immediate and short-term effect of balloon mitral valvuloplasty on global and regional biventricular function: a two-dimensional strain echocardiographic study. Eur Heart J Cardiovasc Imaging 2015; 17:316-25. [DOI: 10.1093/ehjci/jev157] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 05/23/2015] [Indexed: 01/23/2023] Open
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Bülbül Şen B, Ekiz Ö, Rifaioğlu EN, Büyükkaya E, Karakaş MF, Büyükkaya Ş, Bilen P, Akçay AB, Kurt M, Şen N. Assessment of subclinical left ventricular dysfunction in patients with psoriasis by speckle tracking echocardiography: A Speckle Tracking Study. Int J Dermatol 2015; 55:158-64. [DOI: 10.1111/ijd.12703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 02/12/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Bilge Bülbül Şen
- Department of Dermatology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Özlem Ekiz
- Department of Dermatology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Emine Nur Rifaioğlu
- Department of Dermatology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Eyüp Büyükkaya
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Mehmet Fatih Karakaş
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Şule Büyükkaya
- Department of Cardiology; Antakya State Hospital; Hatay Turkey
| | - Perihan Bilen
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Adnan Burak Akçay
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Mustafa Kurt
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
| | - Nihat Şen
- Department of Cardiology; Mustafa Kemal University School of Medicine; Hatay Turkey
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Keskin Kurt R, Nacar AB, Güler A, Silfeler DB, Buyukkaya E, Karateke A, Kurt M, Tanboga IH. Menopausal cardiomyopathy: does it really exist? A case-control deformation imaging study. J Obstet Gynaecol Res 2015; 40:1748-53. [PMID: 24888943 DOI: 10.1111/jog.12368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/02/2013] [Indexed: 11/27/2022]
Abstract
AIM We aimed to evaluate and compare the left ventricular (LV) functions of pre- and postmenopausal women at similar ages with none of the known cardiovascular risk factors, by both conventional and advanced echocardiographic methods such as 2-D strain imaging via speckle tracking echocardiography. METHODS The study population consisted of 40 healthy postmenopausal women aged 45-50 years and 40 healthy premenopausal women of the same age group. None of the subjects had any cardiovascular risk factors and were on hormone replacement therapy. LV strain and strain rate parameters were measured by 2-D strain imaging. The main outcome measure was effect of menopause on LV function. RESULTS There were no significant differences between the pre- and postmenopausal groups with regard to conventional echocardiographic parameters. LV longitudinal strain and LV early diastolic strain rate values were significantly lower in the postmenopausal group when compared to the premenopausal group. Also, there was a significant negative correlation between LV global strain and serum follicle-stimulating hormone (r = -0.349, P = 0.002). CONCLUSION Our study results demonstrated that healthy postmenopausal women had lower LV longitudinal strain values when compared to the healthy premenopausal women of the same age group by speckle tracking echocardiography.
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Affiliation(s)
- Raziye Keskin Kurt
- Department of Obstetrics and Gynecology, Mustafa Kemal University Medical School, Hatay, Turkey
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Nacar AB, Topcu S, Kurt M, Tanboga IH, Karakaş MF, Buyukkaya E, Aksakal E, Sen N, Akcay AB, Bilen E. Effect of Remote Ischemic Postconditioning on Left Ventricular Mechanics. Echocardiography 2015; 32:448-53. [DOI: 10.1111/echo.12677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Selim Topcu
- School of Medicine; Ataturk University; Erzurum Turkey
| | - Mustafa Kurt
- Mustafa Kemal University; School of Medicine; Hatay Turkey
| | | | | | - Eyup Buyukkaya
- Mustafa Kemal University; School of Medicine; Hatay Turkey
| | | | - Nihat Sen
- Mustafa Kemal University; School of Medicine; Hatay Turkey
| | | | - Emine Bilen
- Ankara Ataturk Education and Research Hospital; Ankara Turkey
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LV Mechanics in Mitral and Aortic Valve Diseases. JACC Cardiovasc Imaging 2014; 7:1151-66. [DOI: 10.1016/j.jcmg.2014.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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Bulbul Sen B, Rifaioglu EN, Ekiz O, Buyukkaya E, Kurt M, Karakas MF, Buyukkaya S, Bilen P, Akcay AB, Sen N. Assessment of left ventricular dyssynchrony in patients with psoriasis. Int J Dermatol 2014; 53:1221-7. [PMID: 25219512 DOI: 10.1111/ijd.12192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Psoriasis is an inflammatory disorder, which has been reported to be associated with cardiovascular (CV) risks. Although increased CV risks in psoriasis are well established, there are no data about changes of contraction synchrony in psoriasis. Therefore, we aimed to study the left ventricular (LV) contraction synchrony in patients with psoriasis with narrow QRS and normal ejection fraction. METHODS Fifty patients with psoriasis and 50 age- and sex-matched control subjects were included in the study. LV dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS In the psoriasis group, the mean high-sensitive C-reactive protein values were significantly higher compared with the controls. Peak A velocity, deceleration time, isovolumetric relaxation time, and E/E' values were higher in the psoriasis group; however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters [including standard deviation of Ts of the 12 LV segments (Ts-SD-12), maximal difference in Ts between any two of the 12 LV segments, standard deviation of Ts of the six basal LV segments, and maximal difference in Ts between any two of the six basal LV segments] were found to be higher in the psoriasis group. The patients with ventricular dyssynchrony (a Ts-SD-12 >34.4 ms) were higher in the psoriasis group than the control group (34% vs. 6%, P < 0.01). CONCLUSION In patients with psoriasis with normal ejection fractions and narrow QRS, LV systolic dyssynchrony is an early manifestation of heart involvement and may coexist with diastolic dysfunction.
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Affiliation(s)
- Bilge Bulbul Sen
- Department of Dermatology, Mustafa Kemal University, School of Medicine, Hatay, Turkey
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Sengupta SP, Amaki M, Bansal M, Fulwani M, Washimkar S, Hofstra L, Narula J, Sengupta PP. Effects of Percutaneous Balloon Mitral Valvuloplasty on Left Ventricular Deformation in Patients with Isolated Severe Mitral Stenosis: A Speckle-Tracking Strain Echocardiographic Study. J Am Soc Echocardiogr 2014; 27:639-47. [DOI: 10.1016/j.echo.2014.01.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Indexed: 11/29/2022]
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Karakas MF, Buyukkaya E, Kurt M, Karakas E, Buyukkaya S, Akcay AB, Sen N. Assessment of left ventricular dyssynchrony in dipper and non-dipper hypertension. Blood Press 2013; 22:144-50. [PMID: 23458091 DOI: 10.3109/08037051.2012.745224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Ventricular dyssynchrony is an co-determinant of progression and exacerbation of heart failure (HF). The co-existence of ventricular dyssynchrony with hypertension (HT) and HF were shown, however there is no data regarding the effect of circadian rhythm of blood pressure (BP) on ventricular synchrony. Therefore, we aimed to study the left ventricular synchrony in dipper and non-dipper normotensive and hypertensive participants. METHODS Participants (n = 142) were categorized into four groups as "Normotensive-Dipper" (NT-D) (n = 40), "Normotensive-Non-dipper" (NT-ND) (n = 30), "Hypertensive-Dipper" (HT-D) (n = 38) and "Hypertensive-Non-dipper" (HT-ND) (n = 34). Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS Non-dippers had higher 24-h and night-time BP both in normotensives and hypertensives. The incidence of ventricular dyssynchrony (a Ts-SD-12 > 34.4 ms) was higher in the hypertensive group (47.2% vs 24.3%, p = 0.005). The frequency of ventricular dyssynchrony was higher in the HT-ND group than the HT-D group (58.8% vs 36.8%, p = 0.05); however, the frequency of ventricular dyssynchrony was similar among the normotensives (26.7% vs 22.5%, p = 0.45). Ts-SD-12 and Ts-12 were higher in NT-ND group than the NT-D group. CONCLUSIONS Non-dipping BP pattern was associated with impaired left ventricular contraction synchrony in both normotensive and hypertensive participants, which may be related with short- and long-term effects of HT on myocardium.
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Affiliation(s)
- Mehmet Fatih Karakas
- Department of Cardiology, Mustafa Kemal University, Tayfur Ata Sokmen Medical School, Hatay, Turkey.
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Karakaş MF, Büyükkaya E, Kurt M, Çelik M, Karakaş E, Büyükkaya S, Akçay AB, Sen N. Left ventricular dyssynchrony is an early manifestation of heart involvement in sickle cell anemia. Echocardiography 2013; 30:521-6. [PMID: 23305504 DOI: 10.1111/echo.12085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Sickle cell anemia (SCA) is the most common inherited anemia. Although heart involvement in SCA is well-established, there is no data about changes of contraction synchrony in SCA. Therefore, we aimed to study the left ventricular contraction synchrony in SCA patients with narrow QRS and normal ejection fraction (EF). METHODS Thirty-six patients with SCA and 37 age- and gender-matched control subjects were included in the study. Left ventricular dyssynchrony was investigated by color-coded tissue Doppler imaging. RESULTS The SCA patients had lower hemoglobin (Hb) and higher ferritin, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass index (LVMI), and pulmonary artery pressure. Peak A velocity, Dt, and E/E' values were higher in the SCA group however, E/A ratio and average Em were higher in the control group. LV systolic dyssynchrony parameters including Ts-SD-12, Ts-12, Ts-SD-6, and Ts-6 were found to be higher in SCA group when compared with controls. In addition to that, the patients with ventricular dyssynchrony (a Ts-SD-12 > 34.4 msec) were higher in the SCA group than the control group (55.6% vs. 8.1%, P < 0.001). In the correlation analysis, systolic dyssynchrony parameters were found to be correlated with Hb, ferritin, LVMI, E/A, Dt, Em. CONCLUSION Our results revealed that in SCA patients with normal EF and narrow QRS, left ventricular systolic dyssynchrony was an early manifestation of heart involvement and might be coexisted with or preceding diastolic dysfunction.
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Affiliation(s)
- Mehmet Fatih Karakaş
- Department of Cardiology, Tayfur Ata Sokmen Medical School, Mustafa Kemal University, Hatay, Turkey.
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Sengupta SP, Sengupta PP, Narula J. Echocardiographic Investigations of Myocardial Function in Mitral Stenosis: Making Sense of the Echolalia. Cardiology 2011; 119:142-4. [DOI: 10.1159/000331404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 11/19/2022]
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