Correlation among right ventricular preload, afterload and ejection fraction in mitral valve disease: Radionuclide, echocardiographic and hemodynamic evaluation

Abstract Background Studies on the management of functional tricuspid regurgitation (TR) during mitral valve operations have drawn inconsistent conclusions. This study was designed to compare the treatment strategy of concomitant tricuspid annuloplasty (TAP) against isolated mitral valve replacement (MVR) in rheumatic mitral valve disease patients, and to assess the effect of concomitant TAP on postoperative right ventricular (RV) remodeling and function. Methods One hundred-seventy patients with rheumatic mitral valve disease receiving MVR were categorized into TAP group (n = 124) and non-TAP group (n = 46). Clinical and echocardiographic data were collected preoperatively and at 1-year follow-up. Three-dimensional echocardiographic indices of RV geometry and function were analyzed. Results At baseline, concomitant TAP group had larger RV end-diastolic volume, more decreased RV ejection fraction and RV longitudinal strain than non-TAP group (all P < 0.001). At 1-year follow-up, TAP group had improved RV geometry and function. While adverse changes were observed in non-TAP group. In analysis of variance, the above indices demonstrated significant interaction with different treatment group (all P < 0.001). In multivariate regression analysis, independent of age and Maze procedure, concomitant TAP was associated with postoperative RV volume reduction (P < 0.001), improvement of RV ejection fraction (P < 0.001), and relieved postoperative functional TR severity (P = 0.025). Conclusions Our results suggest that concomitant TAP could improve RV remodeling and function for rheumatic mitral valve disease patients, while those with mild preoperative functional TR who had isolated MVR might experience RV dilation and deterioration of RV function at follow-up. Concomitant surgery for functional TR could be considered for patients undergoing MVR with rheumatic mitral valve disease.

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CMR fast-SENC segmental intramyocardial LV strain monitors decline in heart function before ejection fraction in patient with mitral valve disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.1914 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Montenbruck ◽

S Kelle ◽

S Esch ◽

A.K Schwarz ◽

S Giusca ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Cardiac Function ◽

Mitral Valve Disease ◽

Heart Function ◽

Global Longitudinal Strain ◽

Image Plane ◽

Valve Disease ◽

Peak Strain ◽

Regional Dysfunction

Abstract Background Ejection fraction is the standard metric to analyze cardiac function in the left (LV) or right (RV) ventricles. However, these global metrics are not able to characterize patients in which the heart compensates for regional dysfunction. More sensitive metrics are needed to detect subclinical regional dysfunction before cardiac remodeling results in changes in ejection fraction (EF) and global longitudinal strain (GLS). Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial contraction in 1 heartbeat per image plane. This prospective registry compares segmental fSENC to standard CMR calculations (e.g. LVEF, volumes, mass, etc.) in patients with mitral valve disease. Methods A single center, prospective registry of CMR scans acquired with a 1.5T scanner were evaluated for standard CMR calculations as well as fSENC scans. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments. Results A total of 493 scans in 424 patients with moderate or severe mitral regurgitation were included in the study. Patients had an average (± stdev) age of 60 (15) yrs and BMI of 27 (4) kg/m2; 63% had arterial hypertension, 19% diabetes mellitus, 10% atrial fibrillation, 15% pulmonary disease, and 32% coronary artery disease. Figure 1 shows the non-linear relationship between segmental fSENC strain (% of normal LV segments ≤−17%) versus LVEF (R=0.81). Conclusion Segmental fSENC detects subclinical LV dysfunction before changes in LVEF. Evaluating segmental longitudinal and circumferential fSENC peak strain provides an alternative metric that shows consistent changes in cardiac function in patients with mitral valve disease irrespective of global calculations that are dependent on loading conditions. Funding Acknowledgement Type of funding source: None

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Valvular heart diseases. Ultrastructural study of right ventricular myocardium in tricuspid regurgitation associated with rheumatic mitral valve disease.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.20.976 ◽

1991 ◽

Vol 20 (5) ◽

pp. 976-978

Author(s):

S. Imai

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Ultrastructural Study ◽

Tricuspid Regurgitation ◽

Mitral Valve Disease ◽

Heart Diseases ◽

Ventricular Myocardium ◽

Valve Disease ◽

Valvular Heart Diseases

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006 Left Atrial Ejection Fraction Predicts Future need for Surgery in Asymptomatic Patients With Rheumatic Mitral Valve Disease

Heart Lung and Circulation ◽

10.1016/j.hlc.2020.09.013 ◽

2020 ◽

Vol 29 ◽

pp. S39-S40

Author(s):

R. Roberts-Thomson ◽

A. Baumann ◽

J. Reade ◽

L. Culgan ◽

A. Kaethner ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Mitral Valve Disease ◽

Left Atrial ◽

Valve Disease ◽

Asymptomatic Patients ◽

Left Atrial Ejection Fraction

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Incremental predictive value of echocardiographic indices of right ventricular function in the assessment of long-term prognosis in dogs with myxomatous mitral valve disease

Journal of Veterinary Cardiology ◽

10.1016/j.jvc.2021.12.002 ◽

2021 ◽

Author(s):

Tomoya Morita ◽

Kensuke Nakamura ◽

Tatsuyuki Osuga ◽

Mitsuyoshi Takiguchi

Keyword(s):

Mitral Valve ◽

Right Ventricular ◽

Ventricular Function ◽

Right Ventricular Function ◽

Predictive Value ◽

Mitral Valve Disease ◽

Valve Disease ◽

Long Term Prognosis

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P320 Left atrial mechanics in moderate mitral valve disease: earlier markers of damage

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.173 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

P Alves ◽

A V Marinho ◽

J A Ferreira ◽

J Milner ◽

A Freitas ◽

...

Keyword(s):

Mitral Valve ◽

Ejection Fraction ◽

Strain Rate ◽

Mitral Valve Disease ◽

Left Atrial ◽

Longitudinal Strain ◽

Global Longitudinal Strain ◽

Left Ventricular ◽

Valve Disease ◽

Left Ventricular Ejection

Abstract BACKGROUND Left atrial (LA) mechanics is impaired in mitral valve disease, but it is not clear whether reservoir, conduit or contractile functions are differentially impaired in stenosis (MS) or regurgitation (MR). We aimed to study LA mechanics in patients with moderate MR or moderate MS and identify discriminators of disease. METHODS We conducted a prospective, observational study of 100 patients with isolated moderate MR and 100 patients with moderate MS. LA mechanics with speckle tracking echocardiography (STE) assessed LA reservoir (LA ɛsys and SRs), conduit(LAɛe, SRe), and contractile (LAɛa, SRa) functions. Left ventricle (LV) functional parameters were assessed as well, including LV ejection fraction (LVEF), LV end-diastolic diameter (LVDD) and LV global longitudinal strain (LV-GLS). RESULTS The mean age was 67 ± 14 years and 75% were female. Mean left ventricular ejection fraction (LVEF), LV end-diastolic diameter (LVDD), LV global longitudinal strain (LV-GLS) and systolic pulmonary artery pressure (sPAP) did not differ between MR and MS (table 1).LA indexed volume (LAVi) and LA strain did not vary between MR and MS, but strain rate did. SRs and SRe had better values in MR, whereas SRa had worse values in MR (table 1). SRe (<-0.7%) had the superior discriminative power for MR, with an area under the curve of 0.85, sensitivity of 76% and specificity of 85%. CONCLUSIONS LA strain rate phases were the only parameters that varied between MR and MS. Contractile phase strain rate was more impaired in MR and conduit phase strain rate in MS. This highly specific data reflect the earlier hemodynamic changes occurring in LA in the setting of mitral valve disease. mMR mMS P value LVEF (±SD,%) 57.4 ± 6.4 59.6 ± 4.6 0.145 LV-GLS (±SD, %) -17.7 ± 4.5 -17.1 ± 3.5 0.587 sPAP (±SD, mmHg) 30.3 ± 10.5 32.4 ± 8.3 0.387 LAVi (± SD, ml/m2) 46.3 ± 6.4 48.2 ± 7.4 0.281 LAɛs (± SD, %) 15.8 ± 7.3 13.3 ± 9 0.062 LAɛe (± SD, %) 8.4 ± 4.7 7.1 ± 5.4 0.074 LAɛa (± SD, %) 6.3 ± 4.8 7.4 ± 4.5 0.081 LA SRs (± SD, %) 0.8 ± 0.4 0.6 ± 0.3 0.004 LA SRe (± SD, %) -0.9 ± 0.5 -0.5 ± 0.3 <0.001 LA SRa (± SD, %) -0.5 ± 0.4 -0.8 ± 0.5 0.007

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