Regurgitant Volume/Left Ventricular End-Diastolic Volume Ratio

Abstract Funding Acknowledgements Type of funding sources: None. Background Quantitative evaluation of secondary mitral valve regurgitation (MR) remains an important yet challenging step in the evaluation of this entity. Its severity can be underestimated when using the proximal isovelocity surface area (PISA) method, which does not take left ventricular (LV) volume into account. Normalizing mitral regurgitant volume (Rvol) for the LV end-diastolic volume (EDV) might overcome this key limitation. This study aimed to investigate the prognostic implication of Rvol/EDV ratio in patients with secondary MR. Methods Patients with at least mild secondary MR and reduced left ventricular ejection fraction (<50%) under optimal guidelines-directed medical therapy were retrospectively identified at a single-center. The cohort was divided into terciles according to the RVol/EDV ratio. The primary endpoint was all-cause mortality. Results A total of 572 patients (median age 70 years; 76% male) were included. Median LVEF was 35% (IQR 28-40) and LVEDV was 169 ml (IQR 132-215). Median measures of secondary MR were EROA 14 mm2 (IQR 8-22) and RegVol 23 ml (12-34). During a median follow-up of 3.8 years (interquartile range 1.8 to 6.2 years) there were 254 deaths (44%). The unadjusted mortality incidence increases across terciles distribution. Patients at the 2nd and 3rd terciles of the RVol/EDV ratio showed significantly higher mortality when compared to those at the 1st one (baseline reference) (figure 1). After multivariable analysis, terciles of the Rvol/EDV ratio remained independently associated with increased all-cause mortality (considering the 1st tercile as the reference; adjusted HR for the 2nd tercile 1.46 [95% CI 1.05- 2.02] p = 0.023; adjusted HR for 3rd tercile 1.56 [95% CI 1.09 – 2.22], p = 0.015). Conclusion In patients with secondary MR, Rvol/EDV ratio is independently associated with all-cause mortality. However, the appropriate cut-off to determine any kind of clinical decision remains to be determined. Abstract Figure.

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Cardiac remodelling and haemodynamic characteristics in primary mitral valve regurgitation

Open Heart ◽

10.1136/openhrt-2018-000919 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000919

Author(s):

Rine Bakkestrøm ◽

Ann Banke ◽

Redi Pecini ◽

Akhmadjon Irmukhamedov ◽

Søren Kristian Nielsen ◽

...

Keyword(s):

Diastolic Pressure ◽

Mitral Valve Regurgitation ◽

Left Ventricular ◽

Volume Index ◽

Regurgitant Volume ◽

Clinical Trial Registration ◽

Link Type ◽

End Diastolic Volume ◽

Right Heart Catheterisation ◽

And Function

ObjectiveTo assess the association between cardiac morphology and function assessed with cardiac MRI (CMRI) and haemodynamics at rest and during exercise in patients with primary mitral regurgitation (MR).MethodsIn an observational study, subjects with significant primary MR (N = 46) with effective regurgitant orifice ≥ 0.30 cm2 and left ventricular (LV) ejection fraction > 60% were examined with right heart catheterisation during rest and exercise and CMRI at rest. End-diastolic pressure volume relationship (EDPVR) was assessed using a single beat method using pulmonary capillary wedge pressure (PCWP) and end-diastolic volume. Patients were divided according to normal PCWP at rest (> 12 mm Hg) and with exercise (> 28 mm Hg). Results: Resting regurgitant volume correlated positively with resting PCWP, (r = 0.42, p = 0.002). However, with exercise no association between PCWP and regurgitant volume was seen (r = 0.09, p = 0.55). At rest left atrial (LA) maximal, minimal and volume index at atrial contraction correlated positively with PCWP (r = 0.60; r = 0.55; r = 0.58, all p < 0.001); in contrast none of these correlated with exercise PCWP (all p > 0.2). EDPVR in patients with high PCWP at rest was shifted towards higher volumes for the same pressures. The opposite was seen for patients with high PCWP during exercise where estimated volumes were smaller for the same pressure than patients with normal exercise PCWP.ConclusionIn patients with significant MR the degree of regurgitation and LA dilatation is associated with resting PCWP. However, with exercise this association disappears. Estimation of EDPVR suggests lower LV compliance in patients where PCWP is increased with exercise.Clinical trial registrationURL: https://clinicaltrials.gov/ct2/show/NCT02961647?term=HEMI&rank=1. ID: NCT02961647

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Secondary mitral regurgitation (part 1): volumetric quantification and analysis

Heart ◽

10.1136/heartjnl-2017-312001 ◽

2017 ◽

Vol 104 (8) ◽

pp. 634-638 ◽

Cited By ~ 17

Author(s):

William H Gaasch ◽

Theo E Meyer

Keyword(s):

Mitral Regurgitation ◽

Left Ventricular ◽

Volume Data ◽

Regurgitant Volume ◽

Optimal Method ◽

End Diastolic Volume ◽

Volumetric Quantification ◽

Secondary Mitral Regurgitation ◽

Lv Volume ◽

Secondary Mr

Secondary mitral regurgitation (MR) develops as a consequence of left ventricular (LV) dilatation and dysfunction, which complicates its evaluation and management. The goal of this article is to review the assessment of secondary MR with special emphasis on quantification and analysis of LV volume data. At the present time, the optimal method for making these measurements appears to be cardiac MRI. In severe MR (both primary and secondary), the regurgitant fraction (RF) exceeds 50%, and as a result, the LV end diastolic volume (EDV) is increased. In secondary MR, the ejection fraction is depressed (generally <40%) and despite an RF >50%, the regurgitant volume (RegV) rarely meets the current published criteria for severe MR (>60 mL). The ratio of the RegV to EDV, which is very low in secondary MR, reflects the effect of the RegV on the ventricle and it may be predictive of the fractional change in LV size that can be expected after correction of MR. Accurate measurement of the volumetric parameters is essential to proper management of patients with secondary MR.

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P600Impact of the use of left ventricular mass/end-diastolic volume ratio by 3D echocardiography on 2D derived global longitudinal strain and diastolic function in native hypertensive patients

European Heart Journal ◽

10.1093/eurheartj/ehy564.p600 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

M Lembo ◽

R Esposito ◽

R Sorrentino ◽

M Petitto ◽

C Santoro ◽

...

Keyword(s):

Diastolic Function ◽

Left Ventricular Mass ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Volume Ratio ◽

Left Ventricular ◽

3D Echocardiography ◽

Hypertensive Patients ◽

End Diastolic Volume ◽

Ventricular Mass

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Abstract 11639: Interpretation of Diastolic Function in Hemodialysis Patients: The Importance of a Load Independent Index of Left Ventricular Diastolic Compliance

Circulation ◽

10.1161/circ.130.suppl_2.11639 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ruth F Dubin ◽

Dean Alokozai ◽

Sanjiv J Shah

Keyword(s):

Diastolic Function ◽

Diastolic Pressure ◽

Volume Ratio ◽

Dependent Measure ◽

Left Ventricular ◽

Adverse Outcomes ◽

End Diastolic Volume ◽

Diastolic Compliance ◽

Stage Renal Disease ◽

End Stage

Background: Prior studies of diastolic function in the setting of end-stage renal disease (ESRD) primarily utilize E/e’, a volume dependent measure of left ventricular (LV) filling pressure. While such studies show that high E/e’ is common and associated with adverse outcomes in ESRD, these findings may not be attributable to intrinsic diastolic function. In contrast to E/e’, the LV end-diastolic pressure-volume relationship (EDPVR) (a load independent index of LV diastolic compliance) describes intrinsic LV diastolic function. Therefore, we sought to examine the effects of hemodialysis on EDPVR, and to delineate correlates of EDPVR in the setting of ESRD. We hypothesized that E/e’ and other indices of diastolic function are volume dependent in ESRD, while EDPVR is not. Methods: Twenty-nine patients underwent echocardiography directly before and during the last hour of dialysis. LV diastolic compliance was quantified using a single-beat EDPVR method (P = αVβ). The LV end-diastolic volume at an idealized pressure of 20 mmHg (EDV20) was calculated as a means of comparing EDPVR curves within and between patients (smaller EDV20 = lower diastolic compliance). Results: During hemodialysis, EDV20 did not significantly change (median [IQR] pre-dialysis EDV20 112 [93-113] ml; intra-dialysis EDV20 113 [94-138] ml; p=0.2). However, E/e’ decreased on average by 1.2 absolute units (AU) (median [IQR] pre-dialysis 7.0 [6.0-8.9] AU; intra-dialysis 6.0 [5.1-9.7] AU; p=0.004). E/e’ decreased by 2 AU for every 1 L/hr ultrafiltration rate (p=0.07). Significant correlates of lower pre-dialysis EDV20 (stiffer LV) included higher diastolic blood pressure (DBP) (β=-13 ml EDV20 per 10 mmHg DBP, p=0.005) and concentric LV remodeling, (β=-5ml EDV20 per 0.1 g/ml LV mass/volume ratio, p=0.004). NT-proBNP was associated with higher E/e’, (β=0.2 E/e’ per 1000 pg/ml higher NT-proBNP, p<0.001), but was not a significant correlate of EDV20 (p=0.5). Conclusions: LV end-diastolic compliance (EDV20) is less volume dependent than LV filling pressures (E/e’) in the setting of ESRD, and thus may be a better measure of intrinsic diastolic function than E/e’. Further studies are needed to determine whether EDV20 predicts adverse outcomes in the ESRD population.

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