Pre-Operative Left Ventricular Torsion, QRS Width/CRT, and Post-Mitral Surgery Outcomes in Patients With Nonischemic, Chronic, Severe Secondary Mitral Regurgitation

Secondary mitral regurgitation (MR) develops as a consequence of postinfarction remodelling of the ventricle or other causes of left ventricular (LV) dilatation and dysfunction. The presence of MR amplifies the poor prognosis of the failing ventricle, but it has not been established whether the adverse outcomes stem from the MR or whether the MR is simply a marker of progressive LV dysfunction. In this article, an attempt will be made to clarify the clinical impact of mitral surgery and transcatheter repair in patients with secondary MR. Observational studies indicate symptomatic improvement, but the results of randomised trials are mixed. Furthermore, neither mitral surgery nor transcatheter repair consistently leads to reversal of the adverse LV remodelling. There is, however, general agreement that these procedures do not have a salutary effect on survival. Certainly mitral surgery and transcatheter repair can substantially reduce the mitral regurgitant flow, but inconsistencies and uncertainties regarding clinical outcomes persist in the published literature. Some such problems could be resolved by utilisation of more accurate and reproducible imaging modalities in randomised studies of patients who are most likely to benefit from a reduction in the regurgitant volume—namely those with the most severe MR.

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Alterations in Left Ventricular Torsion and Diastolic Recoil After Myocardial Infarction With and Without Chronic Ischemic Mitral Regurgitation

Circulation ◽

10.1161/01.cir.0000138385.05471.41 ◽

2004 ◽

Vol 110 (11_suppl_1) ◽

pp. II-109-II-114 ◽

Cited By ~ 26

Author(s):

F. A. Tibayan

Keyword(s):

Myocardial Infarction ◽

Mitral Regurgitation ◽

Left Ventricular ◽

Ischemic Mitral Regurgitation ◽

Left Ventricular Torsion ◽

Ventricular Torsion ◽

Chronic Ischemic Mitral Regurgitation

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Left ventricular torsion in primary chronic mitral regurgitation

Heart ◽

10.1136/hrt.2007.126284 ◽

2008 ◽

Vol 94 (5) ◽

pp. 597-603 ◽

Cited By ~ 71

Author(s):

A N Borg ◽

J L Harrison ◽

R A Argyle ◽

S G Ray

Keyword(s):

Mitral Regurgitation ◽

Left Ventricular ◽

Left Ventricular Torsion ◽

Ventricular Torsion

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Assessment of swine left ventricular torsion after left coronary artery occlusion using 2-D speckle tracking imaging

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60346-x ◽

2008 ◽

Vol 7 ◽

pp. 124-124 ◽

Cited By ~ 1

Author(s):

W RUAN ◽

Y SUN ◽

M CAO ◽

Q ZHANG ◽

L LU ◽

...

Keyword(s):

Coronary Artery ◽

Speckle Tracking ◽

Left Coronary Artery ◽

Coronary Artery Occlusion ◽

Artery Occlusion ◽

Left Ventricular ◽

Speckle Tracking Imaging ◽

Left Ventricular Torsion ◽

Ventricular Torsion

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The Improvement of Torsion Assessed by Cardiovascular Magnetic Resonance Feature Tracking after Coronary Artery Bypass Grafting: A Sensitive Index of Cardiac Function

The Heart Surgery Forum ◽

10.1532/hsf.1655 ◽

2017 ◽

Vol 20 (1) ◽

pp. 026 ◽

Cited By ~ 2

Author(s):

Nan Cheng ◽

Liuquan Cheng ◽

Rong Wang ◽

Lin Zhang ◽

Changqing Gao

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Ejection Fraction ◽

Cardiac Function ◽

Feature Tracking ◽

Artery Bypass ◽

Left Ventricular ◽

Rapid Acquisition ◽

Left Ventricular Torsion ◽

Ventricular Torsion

Objective: The aim of this study was to quantify left ventricular torsion by newly applied cardiovascular magnetic resonance feature tracking (CMR-FT), and to evaluate the clinical value of the ventricular torsion as a sensitive indicator of cardiac function by comparison of preoperative and postoperative torsion.Methods: A total of 54 volunteers and 36 patients with previous myocardial infarction (MI) and LV ejection fraction (EF) between 30%-50% were screened preoperatively or postoperatively by MRI. The patients’ short axis views of the whole heart were acquired, and all patients had a scar area >75% in at least one of the anterior or inferior segments. Their apical and basal rotation values were analyzed by feature tracking, and the correlation analysis was performed for the improvement of LV torsion and ejection fraction after CABG. The intra- and inter-observer reliabilities of torsion measured by CMR-FT were assessed.Results: In normal hearts, the apex rotated counterclockwise in the systolic period with the peak rotation as 10.2 ± 4.8°, and the base rotated clockwise as the peak value was 7.0 ± 3.3°. There was a timing hiatus between the apex and base untwisting, during which period the heart recoils and its suction sets the stage for the following rapid filling period. The postoperative torsion and rotation significantly improved compared with preoperative ones. However, the traditional indicator of cardiac function, ejection fraction, didn’t show significant improvement.Conclusion: Left ventricular torsion derived from CMR-FT, which does not require specialized CMR sequences, was sensitive to patients with low ejection fraction whose cardiac function significantly improved after CABG. The rapid acquisition of this measurement has potential for the assessment of cardiac function in clinical practice.

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Left ventricular myocardial work in patients with secondary mitral regurgitation

European Heart Journal ◽

10.1093/ehjci/ehaa946.1902 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

I Yedidya ◽

R.P Lustosa ◽

F Fortuni ◽

P Van Der Bijl ◽

F Namazi ◽

...

Keyword(s):

Mitral Regurgitation ◽

Speckle Tracking ◽

Speckle Tracking Echocardiography ◽

Blood Pressure Measurement ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Lv Function ◽

Work Efficiency ◽

Constructive Work ◽

Secondary Mitral Regurgitation

Abstract Background Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging because LV ejection fraction (LVEF) reflects changes in LV volume without taking into account the direction of the blood flow. LV global longitudinal strain better reflects active LV myocardial deformation but does not incorporate afterload. LV myocardial work derived from pressure-strain loops integrates speckle tracking echocardiography with non-invasive blood pressure measurement. Purpose To evaluate LV myocardial work components to better characterize LV function in patients with SMR. Methods 378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography. Results 145 patients had mild SMR, 130 moderate SMR and 103 severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS (Table 1). While LV constructive work was more impaired in patients with severe SMR, wasted work was lower as compared to mild SMR (Table 1). Consequently, patients with severe SMR had better myocardial work efficiency than patients with mild MR. This could reflect, the regurgitant volume which is pumped into a low pressure chamber (the left atrium) resulting in less myocardial wasted work and preservation of myocardial efficiency. Conclusion In patients with severe SMR, LVEF, LV GLS and myocardial constructive work are more impaired when compared to mild SMR. However, myocardial wasted work is lower, resulting in higher better LV myocardial work efficiency. Funding Acknowledgement Type of funding source: None

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Abstract 964: Effect of Volume Overload on Left Ventricular Torsion and Extra Cellular Matrix

Circulation ◽

10.1161/circ.116.suppl_16.ii_190-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Hosakote M Nagaraj ◽

Thomas S Denney ◽

Steven G Lloyd ◽

David Calhoun ◽

Inmaculada Aban ◽

...

Keyword(s):

Picric Acid ◽

Three Dimensional ◽

Volume Overload ◽

Left Ventricular ◽

Deformation Model ◽

Data Set ◽

Left Ventricular Torsion ◽

Tissue Tagging ◽

Ventricular Torsion ◽

Longitudinal Strains

Background: Muscle fibers are arranged in a spiral network and are connected by extracellular matrix (ECM). LV torsion is increased in the pressure overloaded heart where there is an increase in ECM. However, torsion and its relation to ECM have not been systematically studied in the volume overloaded heart. Hypothesis: The volume overloaded heart has a decrease in LV torsion due a loss of ECM. Methods: Primary mitral regurgitation (MR) (n=29), resistant hypertension (HTN) (n=77) and normal volunteers (NL) (n±37) were studied. Comprehensive cardiac magnetic resonance imaging (MRI) with tissue tagging was performed and analyzed using three-dimensional data set. Torsion was computed by fitting a B-spline deformation model in prolate-spheroidal coordinates to the tag line data. A subset of MR subjects had LV collagen assessed by picric acid Sirius red from biopsy samples taken at the time of surgery. Results: LV ejection fraction was 65% in MR and 70% in HTN. MR demonstrated eccentric remodeling and HTN demonstrated concentric remodeling. HTN had significantly higher torsion angle and systolic twist compared to NL and MR. This was associated with a simultaneous decrease in longitudinal strain. In contrast, MR patients had similar torsion indices, circumferential and longitudinal strains compared to NL. LV biopsy in MR demonstrated a decrease in interstitial collagen compared to NL. Conclusions: As opposed to the pure volume overloaded heart, LV torsional forces are increased in the pressure overloaded heart. This difference may be related to a rearrangement of the laminar structure due to a differential effect on ECM in the volume overloaded versus the pressure overloaded heart.

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