scholarly journals Mitral and tricuspid annulus disjunction frequently coexist

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Aabel ◽  
M Chivulescu ◽  
L A Dejgaard ◽  
M Ribe ◽  
E Gjertsen ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Right Ventricular ◽  
Mitral Valve Prolapse ◽  
Odds Ratio ◽  
Ventricular Arrhythmias ◽  
Mitral Annulus ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Tricuspid Annulus ◽  
Right Ventricular Free Wall

Abstract Background Mitral annulus disjunction (MAD) is an abnormal atrial displacement of the mitral annulus, frequently found in patients with high-risk arrhythmogenic mitral valve prolapse syndrome. It is unknown whether the annulus disjunction extends to the right side of the heart as tricuspid annulus disjunction (TAD), and whether it is associated with right ventricular electrical instability. Purpose We aimed to explore the presence of TAD, and if extended annulus disjunction was associated with ventricular arrhythmias. Methods We included patients with previously described MAD assessed by cardiac magnetic resonance imaging (CMR) in an ambispective cohort study. MAD and TAD was defined as ≥1 mm separation between the respective atrial wall-valve leaflet junction and the top of the ventricular myocardium. TAD was assessed in the lateral and inferior right ventricular free wall by means of the 4-chamber and right ventricular 2-chamber views, respectively. MAD circumference was assessed by a CMR study protocol with six left ventricular long axis views separated by 30 degrees. Mitral valve prolapse was defined as ≥2 mm superior displacement of any part of the mitral leaflets beyond the mitral annulus. Ventricular arrhythmias were defined as aborted cardiac arrest or non-sustained/sustained ventricular tachycardias recorded by electrocardiogram (ECG), stress ECG or Holter monitoring. Results We included 92 patients with MAD (62% female, age 47±16 years, 71% mitral valve prolapse). TAD was found in 48 (52%) patients, both in the lateral (n=40, 83%) and inferior (n=30, 63%) right ventricular free wall. Patients with TAD were older (age 51±16 years vs. 43±14 years, p=0.01), had greater MAD circumference (168±56° vs. 117±62°, p=0.001) and greater MAD distance (9.2±2.9 mm vs. 6.4±2.8 mm, p<0.001). Additionally, patients with TAD had more frequently mitral valve prolapse (40 patients [85%] vs. 25 patients [57%], p=0.003), whereas similar frequency of bileaflet prolapse (17 patients [39%] vs. 10 patients [39%], p=0.99). Ventricular arrhythmias had occurred in 38 (41%) patients, who were younger (age 40±14 years vs. 52±15 years, p<0.001) and had less frequently TAD (14 patients [37%] vs. 34 patients [63%], p=0.01; univariate odds ratio 0.34 [0.15–0.81], p=0.02). However, TAD was not associated with ventricular arrhythmias when adjusted for age (multivariate odds ratio 0.46 [0.18–1.15], p=0.10). Conclusions TAD by CMR was highly prevalent in patients with MAD and was a marker of severe annulus disjunction and mitral valve prolapse. TAD was not associated with more ventricular arrhythmias. This novel marker warrants further research to explore the clinical implications of right-sided annulus disjunction. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council

scholarly journals P1744 Motion and velocity of the different parts of the AV plane. Relation to site and wall length

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Stoylen ◽  
H E Molmen ◽  
H E Dalen
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Individual Variability ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Relative Variance ◽  
The Right

Abstract Background Displacement (MAPSE) and peak systolic velocity (S") of the various parts of the mitral annulus differ. Also, both indices are higher in the right ventricular free wall. We aimed to investigate the relations between wall motion, wall lengths and sites in the left ventricle, as well as comparing to the right ventricle to assess the influence on systolic deformation of the AV-plane. Methods The HUNT study examined 1266 subjects without evidence of heart disease from a mixed urban/rural population of North Trøndelag county, S", linear diastolic left ventricular annulus to apex distance (WL) and MAPSE was measured in the septal, anterior, lateral and inferior points of the mitral annulus. Intra individual variance and relative variance (variance / mean) of S" and MAPSE was calculated and compared to the same variance of the values normalised for wall length (S"/WL and MAPSE/WL). Results Wall lengths, velocities and MAPSE are shown in figure 1. Wall lengths were associated with both MAPSE and S". Both wall lengths and motion were greatest in the free walls of the LV, but smallest in the septal parts of the AVplane. Variances are shown in table 1. Even if intra-individual variances are larger for S" than MAPSE, relative variance for both decreased by 80 - 90% when normalised for wall length. Conclusion There is an intra-individual variability of MAPSE and S" of the LV, corresponding to WL, when the values normalised for WL most of the variability disappears. Intra individual variability of strain and strain rate per wall is less than MAPSE and S" as shown earlier. As the apex is located centrally, walls corresponding to the free walls are longer than those closest to the septum, thus motion and wall length are both greatest corresponding to the LV free walls. Motion of the right ventricular free wall was higher than the LV free wall; TAPSE 2.8 cm, and S" 12.6 cm/s as shown previously. The relation of TAPSE and S" of the right ventricle to wall length will be different, as the afterload in the RV is far less. But as both lateral parts of the AV plane move more than the centre, givinga systolic bending of the AV-planealso as the central part of the AV-plane is centrally anchored to the large arteries as shown in fig. 1. Table 1 WL (cm) MAPSE (cm) MAPSE / WL (% points) S" (cm/s) S" / WL (/s) Mean of 4 walls 9.5 1.6 0.16 8.4 0.87 Variance 0.04 0.04 0.0004 1.2 0.01 Relative variance (%) 2.8 2.7 0.25 12.1 1.4 Wall lengths (WL), displacement(MAPSE), Systolic velocity (S") and mAPSE and S" normalised for WL. Means and intra individual variances. Abstract P1744 Figure. Fig. 1

Differential regional gene expression from cardiac dyssynchrony induced by chronic right ventricular free wall pacing in the mouse

2006 ◽  
Vol 26 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Kenneth C. Bilchick ◽  
Sudip K. Saha ◽  
Ed Mikolajczyk ◽  
Leslie Cope ◽  
Will J. Ferguson ◽  
...  
Keyword(s):  
Gene Expression ◽  
Right Ventricular ◽  
Differential Expression ◽  
Stem Cell Differentiation ◽  
Left Ventricular ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Cardiac Dyssynchrony ◽  
Clinical Prognosis

Routine clinical right ventricular pacing generates left ventricular dyssynchrony manifested by early septal shortening followed by late lateral contraction, which, in turn, reciprocally stretches the septum. Dyssynchrony is disadvantageous to cardiac mechanoenergetics and worsens clinical prognosis, yet little is known about its molecular consequences. Here, we report the influence of cardiac dyssynchrony on regional cardiac gene expression in mice. Mice were implanted with a custom-designed miniature cardiac pacemaker and subjected to 1-wk overdrive right ventricular free wall pacing (720 beats/min, baseline heart rate 520–620 beats/min) to generate dyssynchrony (pacemaker: 3-V lithium battery, rate programmable, 1.5 g, bipolar lead). Electrical capture was confirmed by pulsed-wave Doppler and dyssynchrony by echocardiography. Gene expression from the left ventricular septal and lateral wall myocardium was assessed by microarray (dual-dye method, Agilent) using oligonucleotide probes and dye swap. Identical analysis was applied to four synchronously contracting controls. Of the 22,000 genes surveyed, only 18 genes displayed significant ( P < 0.01) differential expression between septal/lateral walls >1.5 times that in synchronous controls. Gene changes were confirmed by quantitative PCR with excellent correlations. Most of the genes ( n = 16) showed greater septal expression. Of particular interest were seven genes coding proteins involved with stretch responses, matrix remodeling, stem cell differentiation to myocyte lineage, and Purkinje fiber differentiation. One week of iatrogenic cardiac dyssynchrony triggered regional differential expression in relatively few select genes. Such analysis using a murine implantable pacemaker should facilitate molecular studies of cardiac dyssynchrony and help elucidate novel mechanisms by which stress/stretch stimuli due to dyssynchrony impact the normal and failing heart.

scholarly journals THE PROGNOSTIC VALUE OF RIGHT VENTRICULAR FREE WALL STRAIN AFTER LUNG TRANSPLANTATION IN PATIENTS WITH SCLERODERMA

2018 ◽  
Vol 71 (11) ◽  
pp. A1955
Author(s):  
Yuko Soyama ◽  
Marc Simon ◽  
Masataka Sugahara ◽  
Akiko Goda ◽  
Nobuyuki Kagiyama ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Right Ventricular ◽  
Prognostic Value ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall

Association of epicardial fat thickness with left ventricular diastolic function parameters in a community population

2021 ◽  
Author(s):  
Wei Ma ◽  
Baowei Zhang ◽  
Ying Yang ◽  
Litong Qi ◽  
Jin Zhou ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Right Ventricular ◽  
Diastolic Function ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Community Population ◽  
The Mean ◽  
The Right ◽  
The Relationship

Abstract Purpose We examined the relationship between EFT measured by echocardiography and LV diastolic function parameters in a Beijing community population. Methods We included 1004 participants in this study. Echocardiographic parameters including E and A peak velocity, the early diastolic velocities (e’) of the septal and lateral of mitral annulus using tissue doppler imaging, E/e’, and EFT, were measured. EFT1 was measured perpendicularly on the right ventricular free wall at end-diastole in the extension line of the aortic root. EFT2 was the maximum thickness measured perpendicularly on the right ventricular free wall at end-diastole. Multivariate linear regression was used to analyze the relationship between EFT and the mean e’ and E/e’. Results The mean age of the participants was 63.91 ± 9.02 years old (51.4% men). EFT1 and EFT2 were negatively correlated with e’ lat, e’ sep, and e’ mean (p < 0.05), and positively correlated with E/e’ lat, E/e’ sep, and E/e’ mean. Multivariate regression analysis showed that EFT1 and EFT2 were independently and negatively correlated with e’ mean (EFT1: β = −0.089 [95% confidence interval = − 0.177, − 0.000, p = 0.050]; EFT2: β = −0.078 [95% confidence interval = − 0.143, − 0.012, p = 0.020]). There were no interactions between EFT and any covariates, including age or heart groups, sex, BMI, or presence of hypertension, diabetes, or coronary heart disease in relation to LV diastolic dysfunction. Conclusions EFT was negatively and independently correlated with e’ mean, suggesting that more attention to this type of adipose fat is required for cardiovascular disease therapy.

Progressive right ventricular outflow tract fibrosis after repair of tetralogy of Fallot

2020 ◽  
Vol 30 (9) ◽  
pp. 1366-1367
Author(s):  
Gauri R. Karur ◽  
Wadi Mawad ◽  
Lars Grosse-Wortmann
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
T1 Mapping ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Ventricular Free Wall ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
The Right

AbstractObjectives:The objective of this study was to determine the evolution of fibrosis over time and its association with clinical status.Methods:Children with repaired tetralogy of Fallot who had undergone at least two cardiac magnetic resonance examinations including T1 mapping at least 1 year apart were included.Results:Thirty-seven patients (12.7 ± 2.6 years, 61% male) were included. Right ventricular free wall T1 increased (913 ± 208 versus 1023 ± 220 ms; p = 0.02). Baseline cardiac magnetic resonance parameters did not predict a change in imaging markers or exercise tolerance. The right ventricular free wall per cent change correlated with left ventricular T1% change (r = 0.51, p = 0.001) and right ventricular mass Z-score change (r = 0.51, p = 0.001). T1 in patients with late gadolinium enhancement did not differ from the rest.Conclusion:Increasing right ventricular free wall T1 indicates possible progressive fibrotic remodelling in the right ventricular outflow tract in this pilot study in children and adolescents with repaired tetralogy of Fallot. The value of T1 mapping both at baseline and during serial assessments will need to be investigated in larger cohorts with longer follow-up.

scholarly journals P925 An analysis of the impact of etiology vs. impact of hemodynamic variables on the right ventricular free wall deformation in patients with pulmonary hypertension

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N Ojrzynska ◽  
E Kowalik ◽  
M Kowalski ◽  
A Klisiewicz ◽  
M Demkow ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Ventricular Free Wall ◽  
P Value ◽  
Free Wall ◽  
Right Ventricular Free Wall ◽  
Mean Pulmonary Arterial Pressure ◽  
Hemodynamic Variables ◽  
Cardiac Catherization ◽  
The Impact

Abstract Purpose Pulmonary hypertension (PH) is a deadly disease leading to right ventricular (RV) failure. The aim of this study was to establish whether aetiology of PH has a greater impact on RV longitudinal deformation than cardiac catherization parameters. Methods We retrospectively analyzed echocardiographic studies and cardiac catherization parameters of 25 patients with pulmonary hypertension : 13 pts with precapillary PH associated with atrial/ventricular septum defect and 12 pts with postcapillary PH due to dilated cardiomyopathy. We measured regional strain and regional systolic and diastolic strain rates (SR) in right ventricular free wall in basal, mid and apical segments. Results Aside from TAPSE, echocardiographic parameters indicate no difference. Even though mean pulmonary arterial pressure and pulmonary vascular residence significantly higher in patients with precapillary PH, strain was significantly decreased in patients with postcapillary PH. Statistically significant differences were observed between pre- and postcapillary PH patients" strain in apical and mid myocardial segments. Early diastolic strain rate (SR) in apical RV segment in precapillary PH patients was significantly higher than in patients with postcapillary PH. In other myocardial segments there were no differences between systolic, early diastolic and late diastolic SR. Conclusion Our study suggests that RV free wall strain in patients with PH moderately correlate with aetiology of PH. We did not find correlation between higher RA pressure or PVR and worsening of RV function in PH of different aetiologies. Precapillary PH Postcapillary PH p value PA mean pressure (mmHG) 75,2 ± 17,7 42,0 ± 7,3 &lt;0,05 PWR (WU) 15,8 ± 6,7 4,7 ± 2,6 &lt;0,05 RV wall thickenss (mm) 11,0 ± 2,5 5,5 ± 1,0 NS RVIT (mm) 42,7 ± 10,4 42,8 ± 8,1 NS TAPSE (mm) 19,2 ± 4,2 15,6 ± 4,9 &lt;0,05 S" 10,8 ± 2,0 9,4 ± 2,1 NS basal segment strain -16 ± 7 -17 ± 5 NS mid segment strain -18 ± 8 -15 ± 4 &lt;0,05 apical segment strain -19 ± 8 -14 ± 4 &lt;0,05

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