Patterns of left ventricular longitudinal myocardial dysfunction in mitral valve prolapse and effects of valve repair

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Barbier ◽  
G Liu ◽  
S Corona ◽  
M Scorsin ◽  
S Moriggia ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Myocardial Dysfunction ◽  
Systolic Pressure ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Valve Repair ◽  
Similar Reduction ◽  
Systolic Volume ◽  
Lv Dysfunction

Abstract Background Regional longitudinal left ventricular (LV) dysfunction in patients with mitral regurgitation (MR) due to valve prolapse (MVP) with normal ejection fraction has been recently described, with data pointing at dysfunction of the LV base related to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP and severe acute (MRa, n=27) or chronic (MRc, n=41) MR and no coronary disease, undergoing surgical valve repair with 3 months follow-up (FU); 20 normal subjects were used as controls (N). Methods Speckle-tracking echocardiography was performed pre- (Bas), 1 week (1w) and 4 months (4mo) post-operatively to measure longitudinal global (GLPSS, %), regional (RPSS, %) and segmental (SPSS) peak systolic strain. Maximum and minimum mitral annulus (MA) diameters were measured with 3D echo at Bas. We also evaluated: LV end-diastolic volume index (EDVi, ml/m2); ejection fraction (EF, %); left atrial end-systolic volume index (LAVi, ml/m2); non-invasive pulmonary systolic pressure (PSP, mmHg). Results Risk factors (hypertension, diabetes, atrial fibrillation, smoke and previous stroke) were similar in MRc and MRa. At Bas EDVi was larger by definition in MRc (MRc: 102±21, MRa: 67±10 ml/m2, p<0.001) as LAVi (101±46 vs 76±31 ml/m2, p=0.035). Both EF (65±8 vs 64±8 ml/m2) and GLPSS (−20±4 vs −21±5%) were normal, but RPSS was reduced, only at the base (−13±6 vs −13±6%, p= ns; N: −18±2, p<0.03 vs MRc and MRa) in MRc and MRa, with reduced SPSS localized at anterior, lateral and posterior – but not septal – segments. At 1w, EF decreased in both MRc (47±14%, p<0.001 vs Bas) and MRa (56±10%, p=0.014 vs Bas), together with GLPSS (MRc: −11±4%, p<0.001 vs Bas; MRa; −13±4, p<0.001 vs Bas) driven by a prevalent marked decrease in RPSS (MRc: −7±4%, p<0.001 vs Bas; MRa; −8±5, p<0.001 vs Bas) of the LV base. All patients were alive at 3 months with no MACEs, similar reduction of mean MR grade (MRc: 4±0 to 1.9±0.7, p<0.001; MRa: 3.9±0.3 to 0.9±0.9, p<0.001) and PSP (MRc: 50±23 to 29±5 mmHg, p<0.001; MRa: 42±22 to 32±6 mmHg, p=0.039), normal EDVi (MRc: 70±27, MRa: 49±10 ml/m2), dilated LAVi (MRc: 101±46, MRa: 54±13 ml/m2), and reduced GLPSS (MRc: −12±5%, p<0.001 vs Bas; MRa; −15±3, p=0.001 vs Bas) and base RPSS (MRc: −7±6%, p=0.004 vs Bas; MRa; −10±4, p= ns vs Bas). At multivariate analysis, regional dysfunction was not related to the prolapsing scallop, presence of flail, commissure involvement, dimension and geometry of the MA, EF or pulmonary pressures. Conclusions In patients with MVP and severe MR, there is a specific regional longitudinal dysfunction pattern prevalent at the LV base which may be related to the duration of MR but not to annular dilatation or morphology of the prolapsing leaflets. The dysfunction worsens greatly following acute reduction of preload after surgical repair and is still significant at 4mo FU. Funding Acknowledgement Type of funding source: None

scholarly journals P1754 Regional left ventricular longitudinal myocardial dysfunction in mitral valve prolapse could be primary

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Barbier ◽  
O A Annoh ◽  
G Liu ◽  
M Scorsin ◽  
S Moriggia ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Myocardial Dysfunction ◽  
Stroke Volume Index ◽  
Volume Overload ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Volume Index ◽  
Maximum Strain

Abstract Background Regional left ventricular dysfunction in patients with mitral valve prolapse (MVP) and normal ejection fraction has been described by different Authors, and recent data point to a dysfunction (prevalently longitudinal strain) of the myocardium of the LV base secondary to dilatation of the mitral annulus. Purpose To investigate degree and extent of regional LV dysfunction and its mechanisms in patients with MVP, severe regurgitation and normal global systolic function, compared to patients with equivalent degree of regurgitation but functional etiology (FMR). Methods Speckle-tracking echocardiography was performed in 30 controls (N), and in severe primary (MVP, n= 50) or functional (FMR, n= 20) mitral regurgitation, to measure global, regional and segmental longitudinal peak systolic strain (LPSS, %), and time delay of peak maximum strain (TTPd, ms, calculated as time to peak maximum strain - time of aortic valve closure). Maximum and minimum mitral annulus diameters and area were measured with 3D echo. We also evaluated as recommended: LV end-diastolic volume index (EDVi, ml/m2), ejection fraction (EF, %), and left atrial end-systolic volume index (LAESVi, ml/m2) with 2D echo; LV stroke volume index, and non-invasive pulmonary systolic (PSP, mmHg) and diastolic pressures (PDP), mmHg) with Doppler echo. Results Age, heart rate, BSA and systolic blood pressure were similar between groups. Atrial fibrillation was present in 34% of MVP and 71% of FMR patients. LV EF was normal in MVP and reduced in FMR (43 ± 14 % vs N, p<.001). LV EDVi (MVP: 77 ± 20 ml/m2; FMR: 107 ± 35, both p<.001 vs N) and LAESVi (MVP: 91 ± 26 ml/m2; FMR: 80 ± 30, both p<.001 vs N) were similarly increased (volume overload) in MVP and FMR, as were PSP (MVP: 42 ± 23 ml/m2; FMR: 52 ± 25, both p<.001 vs N) and PDP (MVP: 16 ± 6 ml/m2; MVP: 15 ± 5, both p<.001 vs N). In FMR, LPSS was reduced globally (-12.8 ± 3.3, p<.001 vs N and MVP) and similarly at LV base, papillary and apical levels. In contrast, in MVP global (-19.4 ± 3.7%) and apical (-23.4 ± 4.5%) LPSS were normal, whereas LV base (-12.3 ± 5.8%, p=.003 vs N) and papillary (-17.1 ± 4%, p=.024 vs N) LPSS were reduced; further, LPSS reduction was localized to the anterior (-16 ± 4, p=.028 vs N), lateral (-17 ± 5, p=.006 vs N) and posterior (-16 ± 6, p=.007 vs N) segments, and was associated with an increased TTPd in the same segments in MVP but not in FMR patients. At multivariate analysis, degree and localisation of regional myocardial dysfunction in patients with MVP was not related to the prolapsing scallop, dimension of the mitral annulus, degree of volume overload or pulmonary pressures, or stroke volume index. Conclusions In patients with MVP, severe regurgitation and normal EF, there is a specific dysfunction pattern of regional LV longitudinal function which appears to be primary and not dependent on the degree of preload increase, mitral annulus dilatation, or localization of the prolapsing scallop.

scholarly journals Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Gian Marco Rosa ◽  
Andreina D'Agostino ◽  
Stefano Giovinazzo ◽  
Giovanni La Malfa ◽  
Paolo Fontanive ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ace Inhibitor ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
And Gender ◽  
The Impact

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

scholarly journals Stress Echocardiography in Hyperthyroidism

1999 ◽  
Vol 84 (7) ◽  
pp. 2308-2313 ◽  
Author(s):  
George J. Kahaly ◽  
Stephan Wagner ◽  
Jana Nieswandt ◽  
Susanne Mohr-Kahaly ◽  
Thomas J. Ryan
Keyword(s):  
Heart Rate ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Stress Echocardiography ◽  
Maximal Exercise ◽  
Stroke Volume Index ◽  
Work Load ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume

Exertion symptoms occur frequently in subjects with hyperthyroidism. Using stress echocardiography, exercise capacity and global left ventricular function can be assessed noninvasively. To evaluate stress-induced changes in cardiovascular function, 42 patients with untreated thyrotoxicosis were examined using exercise echocardiography. Studies were performed during hyperthyroidism, after treatment with propranolol, and after restoration of euthyroidism. Twenty- two healthy subjects served as controls. Ergometry was performed with patients in a semisupine position using a continuous ramp protocol starting at 20 watts/min. In contrast to control and euthyroidism, the change in end-systolic volume index from rest to maximal exercise was lower in hyperthyroidism. At rest, the stroke volume index, ejection fraction, and cardiac index were significantly increased in hyperthyroidism, but exhibited a blunted response to exercise, which normalized after restoration of euthyroidism. Propranolol treatment also led to a significant increase of delta (Δ) stroke volume index. Maximal work load and Δ heart rate were markedly lower in hyper- vs. euthyroidism. Compared to the control value, systemic vascular resistance was lowered by 36% in hyperthyroidism at rest, but no further decline was noted at maximal exercise. The Δ stroke volume index, Δ ejection fraction, Δ heart rate, and maximal work load were significantly reduced in severe hyperthyroidism. Negative correlations between free T3 and diastolic blood pressure, maximal work load, Δ heart rate, and Δ ejection fraction were noted. Thus, in hyperthyroidism, stress echocardiography revealed impaired chronotropic, contractile, and vasodilatatory cardiovascular reserves, which were reversible when euthyroidism was restored.

Pressure-Volume Relationship By Pharmacological Stress Cardiovascular Magnetic Resonance

2021 ◽  
Author(s):  
Antonella Meloni ◽  
Antonio De Luca ◽  
Cinzia Nugara ◽  
Maria Vaccaro ◽  
Camilla Cavallaro ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Characteristic Curve ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Cardiac Events ◽  
Pharmacological Stress ◽  
Systolic Volume ◽  
Stress Cmr ◽  
Dipyridamole Stress

Abstract Background. The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR.Methods. One-hundred consecutive patients (24 females, 63.76±10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson’s method. Results. The ΔESPVR index showed a good inter-operator reproducibility. Mean ΔESPVR index was 0.48±1.45 mmHg/mL/m2. ΔESPVR index was significantly lower in males than in females. ΔESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower ΔESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower ΔESPVR values. During a mean follow-up of 56.34±30.04 months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a ΔESPVR<0.02 mmHg/mL/m2 predicted the presence of future cardiac events with a sensitivity of 0.79 and a specificity of 0.68. Conclusions. The noninvasive assessment of the ΔESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The ΔESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. ΔESPVR by CMR can be a useful and simple marker for additional prognostic stratification.

scholarly journals Left Ventricular End-Systolic Volume Is a Reliable Predictor of New-Onset Heart Failure with Preserved Left Ventricular Ejection Fraction

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Marina Kato ◽  
Shuichi Kitada ◽  
Yu Kawada ◽  
Kosuke Nakasuka ◽  
Shohei Kikuchi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Adverse Events ◽  
Ejection Fraction ◽  
Prognostic Indicator ◽  
Left Ventricular ◽  
Volume Index ◽  
Univariable Analysis ◽  
Systolic Volume ◽  
End Systolic Volume

Background. Left ventricular (LV) ejection fraction (EF) and LV volumes were reported to have prognostic efficacy in cardiac diseases. In particular, the end-systolic volume index (LVESVI) has been featured as the most reliable prognostic indicator. However, such efficacy in patients with LVEF ≥ 50% has not been elucidated. Methods. We screened the patients who received cardiac catheterization to evaluate coronary artery disease concomitantly with both left ventriculography and LV pressure recording using a catheter-tipped micromanometer and finally enrolled 355 patients with LVEF ≥ 50% and no history of heart failure (HF) after exclusion of the patients with severe coronary artery stenosis requiring early revascularization. Cardiovascular death or hospitalization for HF was defined as adverse events. The prognostic value of LVESVI was investigated using a Cox proportional hazards model. Results. A univariable analysis demonstrated that age, log BNP level, tau, peak − dP/dt, LVEF, LV end-diastolic volume index (LVEDVI), and LVESVI were associated with adverse events. A correlation analysis revealed that LVESVI was significantly associated with log BNP level (r = 0.356, p<0.001), +dP/dt (r = −0.324, p<0.001), −dP/dt (r = 0.391, p<0.001), and tau (r = 0.337, p<0.001). Multivariable analysis with a stepwise procedure using the variables with statistical significance in the univariable analysis revealed that aging, an increase in BNP level, and enlargement of LVESVI were significant prognostic indicators (age: HR: 1.071, 95% CI: 1.009–1.137, p=0.024; log BNP : HR : 1.533, 95% CI: 1.090–2.156, p=0.014; LVESVI : HR : 1.051, 95% CI: 1.011–1.093, p=0.013, respectively). According to the receiver-operating characteristic curve analysis for adverse events, log BNP level of 3.23 pg/ml (BNP level: 25.3 pg/ml) and an LVESVI of 24.1 ml/m2 were optimal cutoff values (BNP : AUC : 0.753, p<0.001, LVESVI : AUC : 0.729, p<0.001, respectively). Conclusion. In patients with LVEF ≥ 50%, an increased LVESVI is related to the adverse events. LV contractile performance even in the range of preserved LVEF should be considered as a role of a prognostic indicator.

Age-related left ventricular function in the mouse: analysis based on in vivo pressure-volume relationships

1999 ◽  
Vol 277 (5) ◽  
pp. H1906-H1913 ◽  
Author(s):  
Bo Yang ◽  
Douglas F. Larson ◽  
Ronald Watson
Keyword(s):  
Contractile Function ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Lv Function ◽  
Mouse Heart ◽  
Stroke Work ◽  
Arterial Elastance ◽  
Systolic Volume ◽  
End Systolic Volume

Our study compared left ventricular (LV) function between senescent and young adult mice through in situ pressure-volume loop analysis. Two groups of mice ( n = 9 each), 6-mo-old and 16-mo-old (senescent) mice, were anesthetized with urethan and α-chloralose, and their LV were instrumented with a Millar 1.4-Fr conductance micromanometer catheter for the acquisition of the pressure-volume loops. The senescent mice had a significantly decreased contractile function related to load-dependent parameters, including stroke volume index, ejection fraction, cardiac output index, stroke work index, and maximum derivative of change in systolic pressure over time. The load-independent parameters, preload recruitable stroke work and the slope (end-systolic volume elastance) of the end-systolic pressure-volume relationship, were significantly decreased in the senescent mice. Heart rate and arterial elastance were not different between the two groups; however, the ventricular-to-vascular coupling ratio (ratio of elastance of artery to end-systolic volume elastance) was increased by threefold in the senescent mice ( P < 0.001). Thus there were significant decreases in contractile function in the senescent mouse heart that appeared to be related to reduced mechanical efficiency but not related to arterial elastance.

scholarly journals 2363

2017 ◽  
Vol 1 (S1) ◽  
pp. 36-36
Author(s):  
Leo Buckley ◽  
Justin Canada ◽  
Salvatore Carbone ◽  
Cory Trankle ◽  
Michele Mattia Viscusi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Stroke Volume ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Stroke Work ◽  
Systolic Volume ◽  
Arterial Blood ◽  
End Systolic Volume

OBJECTIVES/SPECIFIC AIMS: Our goal was to compare the ventriculo-arterial coupling and left ventricular mechanical work of patients with systolic and diastolic heart failure (SHF and DHF). METHODS/STUDY POPULATION: Patients with New York Heart Association Functional Class II-III HF symptoms were included. SHF was defined as left ventricular (LV) ejection fraction<50% and DHF as >50%. Analysis of the fingertip arterial blood pressure tracing captured with a finger plethysmography cuff according to device-specific algorithms provided brachial artery blood pressure and stroke volume. LV end-systolic volume was measured separately via transthoracic echocardiography. Arterial elastance (Ea), a measure of pulsatile and nonpulsatile LV afterload, was calculated as LV end-systolic pressure (ESP)/end-diastolic volume. End-systolic elastance (Ees), a measure of load-independent LV contractility, was calculated as LV ESP/end-systolic volume. Ventriculo-arterial coupling (VAC) ratio was defined as Ea/Ees. Stroke work (SWI) was calculated as stroke volume index×LV end-systolic pressure×0.0136 and potential energy index (PEI) as 1/2×(LV end-systolic volume×LV end-systolic pressure×0.0136). Total work index (TWI) was the sum of SWI+PEI. RESULTS/ANTICIPATED RESULTS: Patients with SHF (n=52) and DHF (n=29) were evaluated. Median (IQR) age was 57 (51–64) years. There were 48 (58%) and 59 (71%) patients were male and African American, respectively. Cardiac index was 2.8 (2.2–3.2) L/minute and 3.0 (2.8–3.3) L/minute in SHF and DHF, respectively (p=0.12). Self-reported activity levels (Duke Activity Status Index, p=0.48) and heart failure symptoms (Minnesota Living with Heart Failure Questionnaire, p=0.55) were not different between SHF and DHF. Ea was significantly lower in DHF compared with SHF patients [1.3 (1.2–1.6) vs. 1.7 (1.4–2.0) mmHg; p<0.001] whereas Ees was higher in DHF vs. SHF [2.8 (2.1–3.1) vs. 0.9 (0.7-1.3) mmHg; p<0.001). VAC was 1.8 (1.3–2.8) in SHF Versus 0.5 (0.4–0.7) in DHF (p<0.001). Compared with SHF, DHF patients had higher SWI [71 (57–83) vs. 48 (39–68) gm×m; p<0.001) and lower PEI [19 (12–26) vs. 44 (36–57) gm×m; p<0.001]. TWI did not differ between SHF and DHF (p=0.14). Work efficiency was higher in DHF than SHF [0.80 (0.74–0.84) vs. 0.53 (0.46–0.64); p<0.001]. DISCUSSION/SIGNIFICANCE OF IMPACT: The results underscore the differences in pathophysiology between SHF and DHF patients with similar symptom burden and exercise capacity. These results highlight the difference in myocardial energy utilization between SHF and DHF.

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