P763 Asymptomatic severe organic mitral regurgitation: Does the anatomic substrate affect the functional response to supine ergometry?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Armenis ◽  
M Kontonika ◽  
M Marinou ◽  
A Motsi ◽  
G Athanassopoulos
Keyword(s):  
Decision Making ◽  
Mitral Regurgitation ◽  
Volume Effect ◽  
Left Ventricular ◽  
Rate Pressure Product ◽  
Lv Function ◽  
Grey Zone ◽  
Asymptomatic Patients ◽  
History Of

Abstract Asymptomatic severe mitral regurgitation (MR) remains a grey zone in decision making for intervention. The predictive role of left ventricular (LV) functional reserve remains uncertain and the potential role of the anatomical substrate has not been elucidated. Aim of the study was to compare the LV function and hemodynamic changes during supine ergometry (Ex) in asymptomatic severe MR between myxomatous (Myx) and degenerative (Deg) substrate. Methods 32 patients with Deg (male M/female F = 15/17) and 19 with MyxS (M/F = 7/12) were studied at rest (R) and Ex. We estimated heart rate (HR), rate-pressure product (HRxBP), LV endsystolic (LVESV)- enddiastolic volume (LVEDV), ejection fraction (EF), LV longitudinal strain (GLS), transmitral E wave (E), ratio E/e, peak tricuspid gradient (TrPG). To adjust for a potential volume effect on GLS, GLS was normalized to volumes and respective ratios were considered (GLS/LVESV, GLS/LVEDV). Parameters were measured at R and Ex and % changes were calculated : %d (Ex-R). Results Myx and Deg had similar chronotropic reserve and HR-BP. Myx were younger, and during Ex they had a greater LVEDV, a greater EF. a smaller E/e, and a smaller TrPG compared with Deg. Myx group, despite having a better GLS both at R and Ex, revealed a smaller % GLS improvement from R to Ex (15% vs 32%). The normalized GLS/LVESV and GLS/LVEDV were similar at R between Myx and Deg, but they showed a smaller improvement during Ex in Myx. (table-results) Conclusion Despite similar severity of MR, asymptomatic patients with MyxS revealed a different dynamic profile during Ex compared with Deg. The underlying MV substrate in organic MR might be related with a different LV adaptation to volume loading combined with subsequent uneven stress induced hemodynamic response. The disparities found might have implications both in the nature history of MR as well as in the decision making for intervention. RESULTS Parameter DegS MyxS p Age(years) 65 ± 11 44 ± 12 <0. 001 LVEDV Ex (ml) 85 + 32 117 ± 41 =0. 007 EF Ex(%) 65 + 7 69 ± 8 =0. 05 GLS R(%) -17.6 ± 6.8 -22.2 ± 4.3 =0. 04 GLS Ex(%) -22 ± 4 -25.0 ± 5.7 =0. 05 % d (Ex-R) LV strain/endsystolic volume 0.84 ± 0.4 -0.54 ± 0.5 =0. 05 E/e" Ex 16.7 ± 8.8 9.7 ± 2.2 =0. 004 TrPG Ex(mmHg) 59 ± 11 44 ± 11 =0. 0001

scholarly journals P903 Myocardial work in moderate to severe aortic versus primary mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Bouziane ◽  
R E Dulgheru ◽  
S Marchetta ◽  
S Khaddi ◽  
F Cozza ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Severe Aortic Regurgitation ◽  
Asymptomatic Patients ◽  
Work Index ◽  
Valvular Stenosis ◽  
Primary Mitral Regurgitation ◽  
Global Work

Abstract Funding Acknowledgements None OnBehalf None BACKGROUND Myocardial work is an emerging non-invasive technic based on echocardiographic pressure-strain loops that assess left ventricular (LV) function. The method was studied in a large variety of pathologies, but its role in the assessment of valvular regurgitations is still unknown. PURPOSE To compare myocardial work indices in moderate and severe aortic and primary mitral regurgitation. METHODS Seventy-eight patients with moderate and severe aortic regurgitation (AR) or primary mitral regurgitation (MR) and preserved LV ejection fraction (LVEF > 50%) were retrospectively analyzed.. Patients with significant valvular stenosis were excluded. Demographic, clinical and echocardiographic data, including LV global longitudinal strain (GLS) and myocardial work indices, were assessed. RESULTS The mean age was 58 ± 14 years, and 46 patients (59%) were men. Thirty seven patients had moderate or severe AR and 41 patients had moderate or severe MR. The two groups were homogeneous in terms of demographic and clinical data, except for age. As expected, diastolic blood pressure was lower in patients with AR compared to MR group (67 ± 8 mmHg vs. 73 ± 10 mmHg, p = 0,003), patients with MR had a higher LVEF compared to AR group (63 ± 6% vs 59 ± 6%, p = 0,03), and a higher left atrial indexed volume (53 ± 16ml/m² vs 34 ± 12ml/m², p < 0.0001). Overall, GLS, myocardial work index (GWI) and myocardial constructive work (GCW) were significantly lower in patients with moderate or severe AR compared to MR ( -18,1 ±3% vs -21,3 ±3,3%, p < 0,0001; 1849 ± 393 vs 2285 ± 499, p < 0,0001; and 2194 ± 395 vs 2576 ± 594, p = 0,003, respectively). Global wasted work (GWW) and global work efficiency (GWE) were similar. When comparing only asymptomatic patients, results were similar, with higher GLS, GWI and GCW in moderate to severe MR vs. AR (-22,9 ± 3,4 vs.-18,4 ± 3,4%, p <0,001; 2446 ± 570 vs. 1927 ± 338, p = 0.001 and 2767 ± 688 vs. 2236 ± 377, p = 0.005). Interestingly, when comparing asymptomatic patients with a LVEF > 50% for AR, and LVEF > 60% for MR, GWI and GCW were significantly lower in MR group, despite higher GLS values (1852 ± 398 vs. 2322 ± 527, p < 0.001; 2194 ± 400 vs. 2615 ± 638, p = 0.005; -22,1 ± 3,3% vs. -18,2 ± 2,9, p < 0.001). CONCLUSION Patients with moderate to severe MR have higher values of GLS, global work index and global constructive myocardial work. This could translate into the fact that in moderate or severe MR, the myocardium develops a higher amount of work than in AR, maybe to account for the loss of stroke volume into the left atrium. In asymptomatic moderate to severe MR with LVEF > 60%, LV myocardium develops less work than in moderate to severe AR with a LVEF > 50%, suggesting maybe a compensated state.

scholarly journals Assessment of global longitudinal strain by speckle tracking echocardiography in patients with severe primary mitral regurgitation

2021 ◽  
Vol 35 ◽  
pp. 19-25
Author(s):  
Nguyen Mai Huong ◽  
Vu Quynh Nga ◽  
Nguyen Quang Tuan
Keyword(s):  
Mitral Regurgitation ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Lv Function ◽  
Optimal Timing ◽  
Lv Dysfunction ◽  
Asymptomatic Patients ◽  
Primary Mitral Regurgitation

Background: In asymptomatic patients with severe primary mitral regurgitation (PMR), early detection of left ventricular (LV) dysfunction indicates the optimal timing of mitral valve surgery and predictes impaired postoperative LV function. Objectives: Evaluation long longitudinal strain by Speckle Tracking in Patients with Severe Primary Mitral Regurgitation Methods and results: 35 preoperative patients with severe PMR and 25 age-matched healthy subjects at Hanoi Heart Hospital from June 2018 to September 2019. Patients with PMR had longitudinal dysfunction by comparison with controls, although EF were similar. Mean global myocardial longitudinal strain (GLS avg) has a linear correlation with FS (r² = 0.127, p <0.05) and EF biplane (r² = 0.216, p <0.005). Conclusion: Longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR.

Elaborating the role of reflection and individual differences in the study of folk-economic beliefs

2018 ◽  
Vol 41 ◽  
Author(s):  
Kevin Arceneaux
Keyword(s):  
Decision Making ◽  
Individual Differences ◽  
Cognitive Processes ◽  
Evolutionary History ◽  
Behavioral Responses ◽  
History Of ◽  
Economic Beliefs

AbstractIntuitions guide decision-making, and looking to the evolutionary history of humans illuminates why some behavioral responses are more intuitive than others. Yet a place remains for cognitive processes to second-guess intuitive responses – that is, to be reflective – and individual differences abound in automatic, intuitive processing as well.

Myocardial Noncompaction

2018 ◽  
Vol 69 (8) ◽  
pp. 2209-2212
Author(s):  
Alexandru Radu Mihailovici ◽  
Vlad Padureanu ◽  
Carmen Valeria Albu ◽  
Venera Cristina Dinescu ◽  
Mihai Cristian Pirlog ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Specific Treatment ◽  
Left Ventricular ◽  
Left Ventricular Noncompaction ◽  
Ventricular Noncompaction ◽  
Genetic Transmission ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
Patients With Heart Failure

Left ventricular noncompaction is a primary cardiomyopathy with genetic transmission in the vast majority of autosomal dominant cases. It is characterized by the presence of excessive myocardial trabecularities that generally affect the left ventricle. In diagnosing this condition, echocardiography is the gold standard, although this method involves an increased risk of overdiagnosis and underdiagnosis. There are also uncertain cases where echocardiography is inconclusive, a multimodal approach is needed, correlating echocardiographic results with those obtained by magnetic resonance imaging. The clinical picture may range from asymptomatic patients to patients with heart failure, supraventricular or ventricular arrhythmias, thromboembolic events and even sudden cardiac death. There is no specific treatment of left ventricular noncompaction, but the treatment is aimed at preventing and treating the complications of the disease. We will present the case of a young patient with left ventricular noncompactioncardiomyopathy and highlight the essential role of transthoracic echocardiography in diagnosing this rare heart disease.

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.

The Role of the Representative: Some Empirical Observations on the Theory of Edmund Burke

1959 ◽  
Vol 53 (3) ◽  
pp. 742-756 ◽  
Author(s):  
Heinz Eulau ◽  
John C. Wahlke ◽  
William Buchanan ◽  
Leroy C. Ferguson
Keyword(s):  
Decision Making ◽  
Political Theory ◽  
Empirical Research ◽  
Body Politic ◽  
Whole Body ◽  
Edmund Burke ◽  
Political Systems ◽  
General Consensus ◽  
History Of

The problem of representation is central to all discussions of the functions of legislatures or the behavior of legislators. For it is commonly taken for granted that, in democratic political systems, legislatures are both legitimate and authoritative decision-making institutions, and that it is their representative character which makes them authoritative and legitimate. Through the process of representation, presumably, legislatures are empowered to act for the whole body politic and are legitimized. And because, by virtue of representation, they participate in legislation, the represented accept legislative decisions as authoritative. But agreement about the meaning of the term “representation” hardly goes beyond a general consensus regarding the context within which it is appropriately used. The history of political theory is studded with definitions of representation, usually embedded in ideological assumptions and postulates which cannot serve the uses of empirical research without conceptual clarification.

scholarly journals Aggravation of functional mitral regurgitation on left ventricle stiffness in type 2 diabetes mellitus patients evaluated by CMR tissue tracking

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yi Zhang ◽  
Wei-feng Yan ◽  
Li Jiang ◽  
Meng-ting Shen ◽  
Yuan Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Mitral Regurgitation ◽  
Strain Rate ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Lv Function ◽  
Peak Strain

Abstract Background Functional mitral regurgitation (FMR) is one of the most common heart valve diseases in diabetes and may increase left ventricular (LV) preload and aggravate myocardial stiffness. This study aimed to investigate the aggravation of FMR on the deterioration of LV strain in type 2 diabetes mellitus (T2DM) patients and explore the independent indicators of LV peak strain (PS). Materials and methods In total, 157 T2DM patients (59 patients with and 98 without FMR) and 52 age- and sex-matched healthy control volunteers were included and underwent cardiac magnetic resonance examination. T2DM with FMR patients were divided into T2DM patients with mild (n = 21), moderate (n = 19) and severe (n = 19) regurgitation. LV function and global strain parameters were compared among groups. Multivariate analysis was used to identify the independent indicators of LV PS. Results The T2DM with FMR had lower LV strain parameters in radial, circumferential and longitudinal direction than both the normal and the T2DM without FMR (all P < 0.05). The mild had mainly decreased peak diastolic strain rate (PDSR) compared to the normal. The moderate had decreased peak systolic strain rate (PSSR) compared to the normal and PDSR compared to the mild and the normal. The severe FMR group had decreased PDSR and PSSR compared to the mild and the normal (all P < 0.05). Multiple linear regression showed that the regurgitation degree was independent associated with radial (β = − 0.272), circumferential (β = − 0.412) and longitudinal (β = − 0.347) PS; the months with diabetes was independently associated with radial (β = − 0.299) and longitudinal (β = − 0.347) PS in T2DM with FMR. Conclusion FMR may aggravate the deterioration of LV stiffness in T2DM patients, resulting in decline of LV strain and function. The regurgitation degree and months with diabetes were independently correlated with LV global PS in T2DM with FMR.

Left ventricular myocardial work in patients with secondary mitral regurgitation

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

scholarly journals Left ventricular ejection fraction reduction due to atrial fibrillation: clinical and echocardiographic predictors

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
O Kobo ◽  
M Postnikov ◽  
D Epstein ◽  
Y Agmon ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Prosthetic Valves ◽  
Ventricular Response ◽  
History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background  The diagnosis of atrial fibrillation (AF) induced cardiomyopathy can be challenging. It relies on ruling out other causes of dilated cardiomyopathy, upon recovery of left ventricular ejection fraction (LVEF) following return to sinus rhythm (SR). Aim  The aim of this study was to identify clinical and echocardiographic predictors for developing new dilated cardiomyopathy in patients with AF or atrial flutter (AFL). Methods  This is a retrospective study conducted in a large tertiary care center. Patients that suffered deterioration of LVEF under 50% during AF demonstrated by pre-cardioversion trans-esophageal echocardiography (TEE) were compared to those with preserved LV function during AF. All patients had documented preserved LVEF at baseline (EF &gt;50%) while in SR. Patients with a previous history of reduced LVEF during SR were excluded. Results From a total of 482 patients included in the final analysis, 80 (17%) patients had reduced LV function and 402 (83%) had preserved LV function during the pre-cardioversion TEE. Patients with reduced LVEF were more likely to be male and with a more rapid ventricular response during AF/AFL. A history of prosthetic valves was also identified as a risk factor for reduced LVEF. Patients with reduced LVEF also had higher incidence of TR and RV dysfunction. Conclusion In "real world" experience, male patients with rapid ventricular response during AF or AFL are more prone to LVEF reduction. Patients with prosthetic valves are also at risk for LVEF reduction during AF/AFL. Lastly, TR and RV dysfunction may indicate relatively long-standing AF with an associated reduction in LVEF.

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