scholarly journals How accurate is cardiac magnetic resonance in quantitation of primary mitral regurgitation?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Baron ◽  
J Kristensson ◽  
F.A Flachskampf
Keyword(s):  
Mitral Regurgitation ◽  
Stroke Volume ◽  
Left Ventricular ◽  
Asymptomatic Patients ◽  
Mitral Prolapse ◽  
Phase Contrast Method ◽  
Lv Volumes ◽  
Potential Factors ◽  
Lv Volume ◽  
The Impact

Abstract Background Since evaluation of mitral regurgitation (MR) in patients with mitral prolapse by echo may be challenging, cardiac MRI (CMR) has been used for identification of patients with severe valve disease. Little is known about potential factors influencing accuracy of this approach. Purpose To study the impact of left ventricular (LV) contouring methods and interobserver variability on quantitation of MR severity. Methods A total of 50 asymptomatic patients with echocardiographically moderate or severe MR were included to LV-REGURGE study and evaluated with CMR by two independent reviewers. LV volumes were calculated on SSFP short axis stack including or excluding intracavitary myocardium into/from the LV volume (“including” or “excluding” method, respectively). Aortic flow volumes were obtained using phase contrast method. Mitral regurgitant volume (RegVol) was calculated by subtracting forward aortic volume from LV stroke volume. Severe MR was diagnosed when RegVol >60mL and/or RegVol/LV stroke volume (RF) >40%. Agreement between MR grading into severe and non-severe, obtained by different tracing methods and different reviewers was assessed using kappa coefficient. Results Left ventricular and mitral regurgitant volumes obtained by “including” method were significantly larger as compared with “excluding” method, see table. “Including” method identified severe MR in 68% while “excluding” method in 57% of cases. Overall agreement between the methods was present in 84% of cases, meaning a substantial rate of agreement (κ 0.67). Within respective methods, interobserver agreement was present in 77% of cases, interpreted as a moderate rate of agreement (κ 0.48–0.54) Conclusion “Including” trabeculae and papillary muscles into the LV cavity volume substantially increases rate of recognizing severe MR, due to larger LV volumes, particularly LV ESV, comparing with the “excluding” method. Moreover, inter-observer variability in similar extent as tracing method seems to impact differentiation between severe and non-severe MR. Funding Acknowledgement Type of funding source: None

P1779Quantitation of severe degenerative mitral regurgitation by echocardiography and CMR with acetate PET for external reference for left ventricular volumes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Baron ◽  
L Holm Orndahl ◽  
T Kero ◽  
J Sorensen ◽  
T Bjerner ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Strong Correlation ◽  
Left Ventricular ◽  
Left Ventricular Volumes ◽  
Asymptomatic Patients ◽  
External Reference ◽  
Golden Standard ◽  
Lv Volumes ◽  
Primary Mitral Regurgitation ◽  
And Function

Abstract Background Quantitative echocardiographic assessment of severity of primary mitral regurgitation (MR) is challenging. CMR is recommended if MR severity cannot be clearly determined, since quantitation of regurgitation as well as of left ventricular (LV) volumes and function is crucial for the indication for surgery especially in asymptomatic patients. Purpose We aimed to compare volumetric measurements obtained from transthoracic echo (TTE) and cardiovascular magnetic resonance (CMR) using ECG-gated [(11)C]acetate PET as reference for assessment of LV volumes. Methods A total of 51 asymptomatic patients with severe primary mitral regurgitation underwent TTE, CMR and PET on the same day. Mitral regurgitant volumes (RVol) were measured by TTE using proximal convergence (PISA) method and by CMR, subtracting aortic forward flow volume from LV stroke volume. LV volumes were measured by TTE, CMR and PET. Results Despite a fair correlation between regurgitant volumes measured by TTE and CMR (r=0.53, p<0.001), PISA method heavily overestimated regurgitant volumes on TTE as compared to CMR (103±60ml vs. 78±35ml, p<0.001). TTE systematically underestimated LV volumes as compared to CMR (see table) despite a good correlation (r=0.81, 0.67 and 0.76 respective for LV EDV, ESV and SV, p<0.001 for all). There was no difference in LV EF between the methods. LV volumes obtained by CMR and PET showed a strong correlation (r=0.92, 0.79 and 0.89 respective for LV EDV, ESV and SV, p<0.001 for all) and agreement (see table). Comparison of TTE, CMR and PET TTE CMR PET PET TTEvs.CMR PET CMRvs.PET F-test LV EDV, ml 145±34 241±57 234±51 <0.001 0.004 <0.001 LV ESV, ml 47±11 76±22 81±23 <0.001 0.067 <0.001L LV SV, ml 99±26 164±38 152±34 <0.001 <0.001 <0.001 LV EF, % 68±5 69±5 65±6 0.236 <0.001 <0.001 Conclusions As compared to CMR, PISA method used by TTE substantially overestimates regurgitant volumes in patients with asymptomatic primary mitral regurgitation. Conversely, LV volumes in spite of good correlation are heavily underestimated by TTE in comparison with CMR. A strong correlation and agreement between LV volumes measured by CMR and PET confirms the accuracy of the former method which is considered as a golden standard for assessment of ventricular function and volumes. Thus, even so-called quantitative echo measures should be understoas essentially semi-quantitative indicators of severity.

P4507Left atrial conduit function modulates functional capacity in heart failure patients acting through the pulsatile component of right ventricular afterload

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Zanaboni ◽  
A Giubertoni ◽  
C Piccinino ◽  
A Panizza ◽  
A Degiovanni ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Right Ventricular ◽  
Real Time ◽  
Functional Capacity ◽  
Left Ventricular ◽  
Lv Volumes ◽  
The Impact ◽  
Conduit Function

Abstract Background It has been suggested that left atrial (LA) characteristics modulate the functional capacity in heart failure (HF) patients through the impact that LA cavity exerts on the pulmonary circulation and the pulsatile component of right ventricular (RV) afterload, as represented by pulmonary arterial compliance (PAC). Purpose Thus, we hypothesized that, in a HF patients' population, a larger relative contribution of LA phasic conduit function (PCF) to the left ventricular (LV) stroke volume would be associated with a heavier right ventricular hemodynamic burden and a reduced functional capacity. Methods 60 sinus rhythm HF subjects (42 males, 67±11 years, ejection fraction [EF] 39±11%, range 20% - 62%) underwent 6 minute walking test (6MWT) and routine transthoracic echocardiography, plus real time 3D acquisitions analyzed with a dedicated echo software package. LV ejection fraction (EF) was obtained from 3D echo acquisitions. LV diastolic dysfunction (DD) was assessed according to current guidelines. Computation of PCF was made by simultaneous gathering real time 3D multibeats (6 cycles) LA and LV volumes, using the formula: PCF(time) = [LV(time) − LV minimum] − [LA maximum − LA(time)] as proposed by Bowman & Kovacs (2004), with PCF expressed as % of LV stroke volume. Atrioventricular compliance (Cn) was also assessed, as proposed by Flachskampf et al. (1992): 1270*(mitral valve area/E wave downslope) and expressed in ml/mmHg. Finally, PAC was obtained as the ratio between RV stroke volume (pulmonary velocity time integral*pulmonary valve annulus area measured from the RV outflow tract diameter) and pulse pressure (obtained from pulmonary and tricuspid regurgitant envelopes) and expressed in ml/mmHg. Results Maximal LA and LV volumes averaged 69±21 ml and 147±47 ml, respectively. The mean value of PCF was 33±12% (range 7% - 58%). Mean 6MWT was 397±162 m. Mean PAC was (3.1±1.1 ml/mmHg). DD grade I, II and III were detected in 38 (63%), 18 (30%) and 4 (7%) of the patients' population, respectively. PCF was independent of LA or LV volumes and EF, but showed a strong direct relation with DD (r=0.62; p<0.0001) and a relevant inverse dependence on Cn (r=−0.48; p=0.0001). For a comparable Cn, dividing patients into tertiles according to 6MWT, it was clear that highest PCF was significantly associated with lowest functional capacity (ANCOVA, figure left). Similarly, dividing patients into tertiles according to PAC, it emerges that highest PCF is significantly associated with most deranged PAC (ANCOVA, figure right), suggesting outmost RV hemodynamic burden. Conclusion PCF is an important parameter to be quantified in HF patients that is dependent on global left heart compliance, being affected by DD, but not LV EF. Furthermore, at a given Cn, PCF is increased in HF patients with lowest functional capacity, likely because RV pulsatile afterload is highest in these subjects.

Contribution of mitral annular excursion and shape dynamics to total left ventricular volume change

2004 ◽  
Vol 287 (4) ◽  
pp. H1836-H1841 ◽  
Author(s):  
C. Carlhäll ◽  
L. Wigström ◽  
E. Heiberg ◽  
M. Karlsson ◽  
A. F. Bolger ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Volume Change ◽  
Mitral Annulus ◽  
Ventricular Volume ◽  
Left Ventricular ◽  
Lv Function ◽  
Shape Variation ◽  
Endocardial Border ◽  
Lv Volume ◽  
The Impact

The mitral annulus (MA) has a complex shape and motion, and its excursion has been correlated to left ventricular (LV) function. During the cardiac cycle the annulus’ excursion encompasses a volume that is part of the total LV volume change during both filling and emptying. Our objective was to evaluate the contribution of MA excursion and shape variation to total LV volume change. Nine healthy subjects aged 56 ± 11 (means ± SD) years underwent transesophageal echocardiography (TEE). The MA was outlined in all time frames, and a four-dimensional (4-D) Fourier series was fitted to the MA coordinates (3-D+time) and divided into segments. The annular excursion volume (AEV) was calculated based on the temporally integrated product of the segments’ area and their incremental excursion. The 3-D LV volumes were calculated by tracing the endocardial border in six coaxial planes. The AEV (10 ± 2 ml) represented 19 ± 3% of the total LV stroke volume (52 ± 12 ml). The AEV correlated strongly with LV stroke volume ( r = 0.73; P < 0.05). Peak MA area occurred during middiastole, and 91 ± 7% of reduction in area from peak to minimum occurred before the onset of LV systole. The excursion of the MA accounts for an important portion of the total LV filling and emptying in humans. These data suggest an atriogenic influence on MA physiology and also a sphincter-like action of the MA that may facilitate ventricular filling and aid competent valve closure. This 4-D TEE method is the first to allow noninvasive measurement of AEV and may be used to investigate the impact of physiological and pathological conditions on this important aspect of LV performance.

Effects of Rest and Exercise on Cardiac Blood Volume Determinations

1997 ◽  
Vol 36 (08) ◽  
pp. 259-264
Author(s):  
N. Topuzović
Keyword(s):  
Radionuclide Ventriculography ◽  
Left Ventricular ◽  
Peak Exercise ◽  
Volume Determination ◽  
Group I ◽  
Lv Volumes ◽  
Group Ii ◽  
Lv Volume

Summary Aim: The purpose of this study was to investigate the changes in blood activity during rest, exercise and recovery, and to assess its influence on left ventricular (LV) volume determination using the count-based method requiring blood sampling. Methods: Forty-four patients underwent rest-stress radionuclide ventriculography; Tc-99m-human serum albumin was used in 13 patients (Group I), red blood cells was labeled using Tc-99m in 17 patients (Group II) in vivo, and in 14 patients (Group III) by modified in vivo/in vitro method. LV volumes were determined by a count-based method using corrected count rate in blood samples obtained during rest, peak exercise and after recovery. Results: In group I at stress, the blood activity decreased by 12.6 ± 5.4%, p <0.05, as compared to the rest level, and increased by 25.1 ± 6.4%, p <0.001, and 12.8 ± 4.5%, p <0.05, above the resting level in group II and III, respectively. This had profound effects on LV volume determinations if only one rest blood aliquot was used: during exercise, the LV volumes significantly decreased by 22.1 ± 9.6%, p <0.05, in group I, whereas in groups II and III it was significantly overestimated by 32.1 ± 10.3%, p <0.001, and 10.7 ± 6.4%, p <0.05, respectively. The changes in blood activity between stress and recovery were not significantly different for any of the groups. Conclusion: The use of only a single blood sample as volume aliquot at rest in rest-stress studies leads to erroneous estimation of cardiac volumes due to significant changes in blood radioactivity during exercise and recovery.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

scholarly journals Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention?

2021 ◽  
Author(s):  
Maria Concetta Pastore ◽  
Giulia Elena Mandoli ◽  
Aleksander Dokollari ◽  
Gianluigi Bisleri ◽  
Flavio D’Ascenzi ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Main Concern ◽  
Cardiac Damage ◽  
Asymptomatic Patients ◽  
Right Ventricular Strain

Abstract Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.

scholarly journals Underfilling decreases left ventricular function in pulmonary arterial hypertension

2021 ◽  
Author(s):  
Hannah Sjögren ◽  
Barbro Kjellström ◽  
Anna Bredfelt ◽  
Katarina Steding-Ehrenborg ◽  
Göran Rådegran ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Stroke Volume ◽  
Arterial Hypertension ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Longitudinal Function ◽  
Right Heart Catheterisation ◽  
Pulmonary Arterial ◽  
Lv Volume

AbstractTo evaluate the association between impaired left ventricular (LV) longitudinal function and LV underfilling in patients with pulmonary arterial hypertension (PAH). Thirty-nine patients with PAH and 18 age and sex-matched healthy controls were included. LV volume and left atrial volume (LAV) were delineated in short-axis cardiac magnetic resonance (CMR) cine images. LV longitudinal function was assessed from atrio-ventricular plane displacement (AVPD) and global longitudinal strain (GLS) was assessed using feature tracking in three long-axis views. LV filling was assessed by LAV and by pulmonary artery wedge pressure (PAWP) using right heart catheterisation. Patients had a smaller LAV, LV volume and stroke volume as well as a lower LV-AVPD and LV-GLS than controls. PAWP was 6 [IQR 5––9] mmHg in patients. LV ejection fraction did not differ between groups. LV stroke volume correlated with LV-AVPD (r = 0.445, p = .001), LV-GLS (r = − 0.549, p < 0.0001) and LAVmax (r = .585, p < 0.0001). Furthermore, LV-AVPD (r = .598) and LV-GLS (r = − 0.675) correlated with LAVmax (p < 0.0001 for both). Neither LV-AVPD, LV-GLS, LAVmax nor stroke volume correlated with PAWP. Impaired LV longitudinal function was associated with low stroke volume, low PAWP and a small LAV in PAH. Small stroke volumes and LAV, together with normal LA pressure, implies that the mechanism causing reduced LV longitudinal function is underfilling rather than an intrinsic LV dysfunction in PAH.

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Cardiology ◽  
2015 ◽  
Vol 130 (2) ◽  
pp. 82-86
Author(s):  
H.M. Gunes ◽  
G.B. Guler ◽  
E. Guler ◽  
G.G. Demir ◽  
S. Hatipoglu ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Lv Function ◽  
Vena Contracta ◽  
Atherosclerotic Lesions ◽  
Lv Dysfunction ◽  
Echocardiographic Parameters ◽  
Artery Disease ◽  
The Impact

Objective: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Methods: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Results: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Conclusion: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

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