scholarly journals Stress echocardiography and outcomes after cardiac surgery in patients with ischemic mitral regurgitation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
D Shmatov ◽  
G Kim ◽  
Q Ciampi ◽  
R Citro ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Wall Motion ◽  
Pulmonary Pressure ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
The Difference ◽  
B Lines

Abstract Background Ischaemic mitral regurgitation (IMR) is a frequent complication of coronary artery disease. This is generally associated with double mortality rates. Poor prognosis could be observed despite successful cardiac surgery. There is a gap about predictors of further negative outcomes after surgical treatment. Owing to the dynamic nature of IMR, we hypothesize that multiparametric stress echocardiography (SE) would be helpful in assessing risk stratification. Aim: To evaluate the relationship between multiparametric SE parameters and outcomes after cardiac surgery in patients with IMR. Methods We prospectively enrolled 30 patients (62.7±8.5 yrs, 18 men), who have severe IMR by ESC classification, referred for coronary artery bypass grafting (CABG) with or without mitral surgery. Before cardiac surgery, the patients performed semi-supine bicycle multiparametric SE. Wall motion abnormalities, systolic and diastolic volumes of left ventricle, B-lines (lung congestion feature), left atrium volume, pulmonary pressure, mitral regurgitation volume, and effective regurgitation orifice area (EROA) were assessed before and during exercise. Ejection fraction (EF) and left contractile reserve were calculated. All-cause death was an endpoint. Results All patients had indications for CABG due to severe three-vessel disease. Before exercising, EF was 42±12%, end-diastolic volume was 167±49 ml, systolic volume of left ventricle was 86±39 ml, left atrium was 103±37 ml, global longitudinal strain was 12±4%, index of wall motion abnormality was 1.83±0.48, EROA was 0.39±0.22 cm2, regurgitation volume was 58±27 ml, systolic pulmonary pressure was 43±16 mmHg, and B-lines were 2.4±2. During exercise, EF was 44±17%, end-diastolic volume was 148±54 ml, systolic volume of left ventricle was 98±44 ml, index of wall motion abnormality was 2.30±0.49, EROA was 0.45±0.2 cm2, regurgitation volume was 70±32 ml, systolic pulmonary pressure was 51±14 mmHg, and B-lines were 5.4±3.3. A median follow-up time was 332 days (224–335). ROC analysis demonstrated that left ventricle end-diastolic volume during exercise (the cut-off value 192 ml, area under the ROC curve 0.77, p<0.03), EROA during exercise (the cut-off value 0.37 cm2, the area 0.86, p<0.0003), regurgitant volume during stress (the cut-off value 82 ml, the area 0.79, p<0.02), the difference between stress and rest B-lines (the cut-off value 6 lines, the area 0.83, p<0.0001), the difference between stress and rest EROA (the cut-off value 0.15 cm2, the area 0.77, p=0.05) were associated with death. Conclusion The stress echocardiographic parameters were associated with increased mortality after cardiac surgery in patients with IMR over the 1-year follow-up. B-lines (objective evidence of severe congestive heart failure), EROA, regurgitation volume (severity of mitral regurgitation during exercise) were all associated with worse outcome. These preliminary results should be confirmed in the larger studies. FUNDunding Acknowledgement Type of funding sources: None.

P3808iBox-CRT: Better response, less complicated, equally fast

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Aguiar Ricardo ◽  
A Nunes-Ferreira ◽  
J Rigueira ◽  
J Agostinho ◽  
R Santos ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Response Rate ◽  
Control Group ◽  
Conduction Delay ◽  
Study Group ◽  
Automatic Assessment ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
The Mean

Abstract Introduction The optimization of the left ventricle (LV) pacing site guided by the electrical delay increases CRT response rate (RR), however it's necessary to develop technology that allows its universal use. Purpose The aim is automatically, and operator-independent, access the conduction delay between the right ventricular (RV) stimulus and the LV available veins in order to select the LV pacing site. It is further intended to compare the total procedure and radiation times in relation to an historical control group. Methods Prospective, single-center study that included patients undergoing CRT implant according to the current ESC Guidelines. All patients were submitted to a clinical, electrocardiographic and echocardiographic basal evaluation prior to CRT implantation and at 6 months of follow-up. To evaluate conduction delays between the RV lead and the LV available veins (RV-LV delay), an external interface - intelligent Box for CRT (iBox-CRT) was used. Four measurements in at least two different tributary veins were made. The implant of all the LV leads was guided by the longest measured delay. A positive response to CRT was defined as an improvement of >10% in left ventricle ejection fraction (LVEF) or a reduction of end-systolic volume (ESV)>15%. The results were compared to a control group (CG) of pts submitted to CRT implantation in the conventional way. Results 60 patients were included (68.3% males, 38% ischemic, mean age 67.4±10.2 years) and submitted to CRT implant (37 CRT-P; 23 CRT-D). At basal evaluation, LVEF was 28±7%, end-diastolic volume (EDV) was 200±73ml and ESV 145±64ml. CG (n=51) had similar characteristics. The RR was 85.7%, significantly higher compared to the CG (55.9%, p=0.003). The ESV reduced 38.2±3% in responders vs 5.7±2% in non-responders (NR) (p=0,005), EDV reduced 33.3±16% in responders vs 13.6±10% in NR (p=0.002), the mean LVEF improved 11% in responders vs −1% in NR (p=0.02). At follow-up, the mean ESV in the study group (SG) was 89±44 ml vs 132±75ml in the CG (p=0.002) and the EDV 136±51 vs 190±78 (p=0.007). In addition to a much better response rate, the responders in the study group had significantly higher mean LVEF at follow-up (39±11% vs 37±7%, p=0.032). The mean intra-procedure RV-LV delay was 187±34mseg. In the responder group the baseline delay was usually higher (190±35 msec) vs NR group RV-LV delay (165±23 msec; p=NS). Compared with CG, the automatic assessment of RV-LV delay with iBox-CRT did not increase fluoroscopy time (15±16min vs 18±16; p=NS) and shortened procedure time (65±34 vs 108±83min, p<0.005). Conclusions The iBox-CRT use enabled an automatic and operator independent RV-LV delays measurement, in order to implant the LV lead at the most delayed site. This technique translated into a major increase in CTR response rate, not compromising the procedure duration nor increasing the radiation exposure.

Extended Myectomy for Hypertrophic Obstructive Cardiomyopathy

2012 ◽  
Vol 15 (5) ◽  
pp. 251
Author(s):  
Changqing Gao ◽  
Chonglei Ren ◽  
Cangsong Xiao ◽  
Yang Wu ◽  
Gang Wang ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Surgical Procedures ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Systolic Anterior Motion ◽  
Anterior Leaflet ◽  
Septal Myectomy ◽  
The Mean

<p><b>Background:</b> The purpose of this study was to summarize our experience of extended ventricular septal myectomy in patients with hypertrophic obstructive cardiomyopathy (HOCM).</p><p><b>Methods:</b> Thirty-eight patients (26 men, 12 women) with HOCM underwent extended ventricular septal myectomy. The mean age was 36.3 years (range, 18-64 years). Diagnosis was made by echocardiography. The mean (mean � SE) systolic gradient between the left ventricle (LV) and the aorta was 89.3 � 31.1 mm Hg (range, 50-184 mm Hg) according to echocardiographic assessments before the operations. Moderate or severe systolic anterior motion (SAM) of the anterior leaflet of the mitral valve was found in 38 cases, and mitral regurgitation was present in 29 cases. Extended ventricular septal myectomy was performed in all 38 cases. The results of the surgical procedures were evaluated intraoperatively with transesophageal echocardiography (TEE) and with transthoracic echocardiography (TTE) at 1 to 2 weeks after the operation. All patients were followed up with TTE after their operation.</p><p><b>Results:</b> All patients were discharged without complications. The TEE evaluations showed that the mean systolic gradient between the LV and the aorta decreased from 94.8 � 35.6 mm Hg preoperatively to 13.6 � 10.8 mm Hg postoperatively (<i>P</i> = .0000) and that the mean thickness of the ventricular septum decreased from 28.3 � 7.9 mm to 11.8 � 3.2 mm (<i>P</i> = .0000). Mitral regurgitation and SAM were significantly reduced or eliminated. During the follow-up, all patients promptly became completely asymptomatic or complained of mild effort dyspnea only, and syncope was abolished. TTE examinations showed that the postoperative pressure gradient either remained the same or diminished.</p><p><b>Conclusions:</b> Extended ventricular septal myectomy is mostly an effective method for patients with HOCM, and good surgical exposure and thorough excision of the hypertrophic septum are of paramount importance for a successful surgery.</p>

Biplane ventriculography in the rat

1986 ◽  
Vol 250 (1) ◽  
pp. H131-H136
Author(s):  
J. L. Heckman ◽  
L. Garvin ◽  
T. Brown ◽  
W. Stevenson-Smith ◽  
W. P. Santamore ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Methyl Methacrylate ◽  
High Speed ◽  
Water Displacement ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume

Biplane ventriculography was performed on nine intact anesthetized rats. Images of the left ventricle large enough for analysis were obtained by placing the rats close to the radiographic tubes (direct enlargement). Sampling rates, adequate for heart rates of 500 beats/min, were obtained by filming at 500 frames/s. From the digitized silhouettes of the left ventricle the following information was obtained (means +/- SE): end-diastolic volume 0.60 +/- 0.03 ml, end-systolic volume 0.22 +/- 0.02 ml, stroke volume 0.38 +/- 0.02 ml, ejection fraction 0.63 +/- 0.02, cardiac output 118 +/- 7 ml/min, diastolic septolateral dimension 0.41 +/- 0.01 mm, diastolic anteroposterior dimension 0.40 +/- 0.01 mm, diastolic base-to-apex dimension 1.58 +/- 0.04 mm. To determine the accuracy with which the volume of the ventricle could be measured, 11 methyl methacrylate casts of the left ventricle were made. The correlation was high (r = 0.99 +/- 0.02 ml E) between the cast volumes determined by water displacement and by use of two monoplane methods (Simpson's rule of integration and the area-length method applied to the analysis of the anteroposterior films) and a biplane method (area-length). These results demonstrate that it is possible to obtain accurate dimensions and volumes of the rat left ventricle by use of high-speed ventriculography.

scholarly journals P1573 Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Piatkowski ◽  
J Kochanowski ◽  
M Budnik ◽  
M Grabowski ◽  
P Scislo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Odds Ratio ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Multivariable Logistic Regression Analysis ◽  
Late Recovery

Abstract Late recovery of left ventricular function in patients with non-severe ischemic mitral regurgitation and multivessel disease qualified to cardiosurgery treatment. Purpose In patients (pts) after myocardial infarction (MI) with chronic left ventricle (LV) dysfunction, the presence and degree of ischemic mitral regurgitation (IMR) are predominantly related to LV remodelling and mitral valvular deformation. The aim of this study was to compare functional recovery (LVFR) as well as reverse remodelling of the left ventricle (LVRR) in pts with non-severe IMR qualified for cardiosurgical treatment - coronary artery bypass grafting alone (CABGa) or CABG with mitral repair (CABGmr in the 12-month follow-up. Materials and methods A total of 100 pts (mean age 64,4 ± 7,9 years) after MI, eligible for CABG, were included in a prospective study. Echo and clinical assessment were performed before and 12-months after surgery. Pts were referred for CABG a(gr.1; n = 74) or CABGmr (gr.2; n = 26) based on clinical assessment, 2D echo at rest and exercise and myocardial viability assessment (low dose dobutamine - dbx). Effective regurgitation orifice area (EROA) was used for quantitative IMR assessment. An increase in EF≥ 5% (ΔEF) from baseline value was considered as LVFR. A decrease in LV end-systolic volume &gt; 15% from baseline value was considered as LVRR. Multivariable logistic regression analysis was used to identify the strongest factors of lack of LVFR and LVRR. Results An LVFR was observed, at late control, in 35 (49%) of pts in the CABGa group and in 11 (48%) of pts in CABGmr group (p = 0,948). LVRR was observed in 41 (56%) of pts in the CABGa group and in 16 (70%) of pts in CABGmr group 12 months follow-up (p = 0,5). In pts with LVFR, there was a lower incidence of at least moderate IMR at follow-up (ΔEF dbx≥5% vs ΔEFdbx &lt; 5%:11% vs 30% pts; p = 0,05). Multivariable logistic regression analysis revealed that in both CABGa and CABGmr group only preoperative age and EF changes during stress echo remained the independent predictors of the lack of LVFR in 12 months follow-up (table 1). Conclusions 1. LVFR and LVRR were reported in most of the pts in both analyzed groups. 2. Preoperative assessment of changes EF during dbx (ΔEFdbx)can be used to identify pts with IMR at increased risk of lack of improvement in LV function and risk of residual IMRin 12-month f-up after surgery. Parameters Odds ratio (OR) Odds ratio (OR) p CABGa vs CABGmr 0,644 0,215 - 1,927 0,432 Age (increase by every 5 years) 1,11 1,039 - 1,879 0,003 ΔEF dbx (increase by every 5%) 0,21 0,096 - 0,46 &lt;0,001 Table 1. Prognostic factors lack improvement in left ventricle function.

scholarly journals 1180 2D and 3D assessment of the left ventricle volume and ejection fraction in a general population

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Ericsson ◽  
B Tayal ◽  
K Hay Kragholm ◽  
T Zaremba ◽  
N Holmark Andersen ◽  
...  
Keyword(s):  
General Population ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Large Population ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Significant Difference ◽  
End Systolic Volume ◽  
The Mean ◽  
2D And 3D

Abstract Introduction In standard practice, LV volumes and EF are estimated by 2D technique. 3D echocardiographic assessment seems more reliable; however, this method has not yet been validated in the general population. Purpose To validate 3D echocardiography in a large population sample and investigate differences between 2D and 3D LVEF and volumes Methods In The Copenhagen City Heart Study, 4466 echocardiograms were available for analysis. The echocardiograms were obtained during four consecutive heartbeats in both 2D and 3D with GE Vivid E9. Offline analysis was performed on EchoPac v. 201. LVEF was calculated by the modified Simpsons Biplane Auto EF for 2D and by the 4LVQ method for 3D. Results The study included 2090 echocardiograms. The mean 2D LVEF was 57.3 ± 6.1% (IQR 54 - 61%) and 51.7 ± 7.9% (IQR 47 - 57%) by 3D. The mean end-diastolic volume (EDV) and end-systolic volume (ESV) by 2D and 3D techniques were: EDV 2D 106.1 ± 29.6 ml vs EDV 3D 128.2 ± 32.3 ml , ESV 2D 45.7 ± 15.6 ml vs. ESV 3D 45.7 ± 20.7 , p &lt; 0.05 among all variables. The average difference of means between 2D and 3D LVEF was 5.6 ± 11.2%, -22.1 ± 56.8 ml for EDV, and -16.9 ± 32.9 ml for ESV. The correlation coefficient for LVEF was 0.42, EDV 0.76 and for ESV 0.70. Conclusion In our study, we found a significant difference in both LVEF and ventricular volumes when comparing 2D echocardiograms with 3D. 3DE had, in general, lower LVEF, higher EDV and ESV compared to 2D. Table 1: Summary of results Table 1 - Summary of results n = 2090 Variable Min Max Mean IQR (25-75) p-value LVEF, 2D (%) 18 76 57.3 ± 6.1 54-61 &lt; 0.05 LVEF, 3d (%) 13 77 51.7 ± 7.9 47-57 &lt; 0.05 EDV, 2D (ml) 13 275 106.1 ± 29.6 85-123.8 &lt; 0.05 EDV, 3D (ml) 50 270 128.2 ± 32.3 106-148 &lt; 0.05 ESV, 2D (ml) 15 150 45.7 ± 15.6 35-54 &lt; 0.05 ESV, 3D (ml) 13 185 45.7 ± 20.7 48-74 &lt; 0.05 LVEF: left ventricle ejection fraction, EDV: end-diastolic volume, ESV: end systolic volume, IQR: Inter-quartile range Abstract 1180 Figure 1: Correlation and BA-plot

scholarly journals 428 Prognostic implications of the relationship between effective regurgitant orifice area and left ventricle end diastolic volume in patients with functional mitral regurgitation treated with MitraClip

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Melillo ◽  
C Godino ◽  
F Ancona ◽  
A Sisinni ◽  
S Stella ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Clinical Outcome ◽  
Mitral Regurgitation ◽  
Primary Outcome ◽  
Functional Mitral Regurgitation ◽  
Orifice Area ◽  
End Diastolic Volume ◽  
Prognostic Implications ◽  
Regurgitant Orifice Area ◽  
The Relationship

Abstract Funding Acknowledgements none Background The distinction between proportionate and disproportionate functional mitral regurgitation (FMR), based on the relationship between effective regurgitant orifice area (EROA) and left ventricle end diastolic volume (LVEDV), has recently been proposed as a possible new clinical and physiopathological framework to identify patients that could likely benefit from transcatheter mitral repair. Purpose The aim of our study was to explore the possible prognostic implications of the EROA/LVEDV ratio in patients with FMR treated with MitraClip. Methods – Baseline EROA/LVEDV was calculated in 137 patients with at least moderate-to-severe, symptomatic FMR treated with MitraClip. All patients underwent clinical, biochemichal and echocardiographic evaluation before MitraClip. EROA was calculated using PISA method. The primary outcome was a composite end-point of all-cause death or re-hospitalization for heart failure (HF). Results – The median follow-up was 1.1 years. The primary outcome occurred in 59 patients (43 %). Population study showed a LVEDVi 113.52± 32.16 mL/m2, LVEF 29.75± 10.06% and EROA 39.45± 15.43 mm2.. The cut-off value of EROA/LVEDV ratio for primary outcome, identified by receiver operating characteristic curve, was 0.15 (AUC 0,65, p = 0.002) with a sensitivity and specificity of 78% and 52%, respectively. Patients were divided in two groups according to the identified cut-off. Patients with higher ratio (Group I, n = 88) presented a less dilated LV (LVEDVi: 105.1 ± 29.6 mL/m2 vs 128.2 ± 31.9 mL/m2, p &lt; 0.001; LVESVi: 73.1 ± 27.7 mL/m2 vs 94.9 ± 29.05 mL/m2, p &lt; 0.001), and a more severe MR (EROA: 47.9 ± 12.1 mm2 vs 25.1 ± 8.3 mm2, p &lt; 0.001; vena contracta: 7.2 ± 1.3 mm vs 6.5 ± 1.3 mm, p = 0.008). There were no significant differences of left ventricle ejection fraction, right ventricle systolic function and systolic pulmonary pressure between the groups. At univariate analysis, EROA/LVEDV ratio &gt;0.15 (HR = 2.223, 95% CI 1.121-4.411, p = 0.022), baseline evidence of atrial fibrillation (HR = 1.949, 95% CI 1.156-3.283, p = 0.012) and baseline pro-BNP (HR= 1.000, 95% CI 1.000-1.000, p = 0,001) were associated with a worse clinical outcome. At multivariate Cox-regression analysis, both EROA/LVEDV ratio &gt;0.15 and baseline pro-BNP values were identified as independent predictors (HR 2.941, 95% CI 1.035-8.353, p = 0.043; HR = 1.000, 95% CI 1.000-1.000, p = 0.002, respectively). At Kaplan-Meier survival analysis, patients with EROA/LVEDV &gt;0.15 had a significant lower freedom from composite endpoint (log-rank χ2 =5.517, p= 0.019; Fig. 1). Conclusion Our data show that EROA/LVEDV ratio was an independent predictor of adverse clinical outcome in FMR patients treated with MitraClip. This preliminary experience shows that this index could help to identify subgroups of patients with potential different clinical benefits from Mitraclip therapy. However, further and extended data are needed to provide more precise evidence. Abstract 428 Figure. Fig. 1

Dimensional analysis of the left ventricle: effects of acute aortic regurgitation

1975 ◽  
Vol 228 (2) ◽  
pp. 536-542 ◽  
Author(s):  
SJ Leshin ◽  
LD Horwitz ◽  
JH Mitchell
Keyword(s):  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Catheter Technique ◽  
End Systolic Volume

The effects of acute severe aortic regurgitation on the left ventricle were investigated in conscious, chronically instrumented dogs. Left ventricular dimensions and volumes were measured from biplane cineradiographs of beads positioned near the endocardium. Data were collected before and after the production of aortic regurgitation by a catheter technique. The aortic regurgitation resulted in increases in mean aortic pulse pressure from 44 to 73 mmHg (P smaller than 0.001), heart rate from 87 to 122 beats/min (P smaller than 0.02), and left ventricular end-diastolic pressure from 11 to 25 mmHg (P smaller than 0.05). Mean end-diastolic volume rose from 61 to 69 cc (P smaller than 0.001), while end-systolic volume remained unchanged at 37 cc. The end-diastolic dilatation following regurgitation was asymmetrical in that the increase in size was due principally to an increase in the septal-lateral axis. The acute volume load of aortic regurgitation was accomplished by an increase in end-diastolic volume, i.e., the Frank-Starling mechanism. The tachycardia probably reflects augmented cardiac sympathetic activity, but the constant end-systolic volume at a similar mean systolic pressure suggests that the net contractile state was unchanged.

scholarly journals Dimensional analysis of the ventricle of an in situ perfused trout heart using echocardiography

1992 ◽  
Vol 166 (1) ◽  
pp. 47-60 ◽  
Author(s):  
C. E. Franklin ◽  
P. S. Davie
Keyword(s):  
Stroke Volume ◽  
Regression Line ◽  
Systolic Volume ◽  
Output Pressure ◽  
End Diastolic Volume ◽  
Linear Dimensions ◽  
End Systolic Volume ◽  
The Difference ◽  
Line Slope

The linear dimensions of the ventricle of an in situ perfused trout heart were measured with an ultrasound scanner. Using a pyramidal model, linear dimensions taken from real-time, two-dimensional, echotomographic images of the ventricle were used to calculate ventricular end-diastolic and end-systolic volumes and, by the difference between them, stroke volumes for various filling and output pressures. Stroke volumes calculated from the ultrasound measurements were significantly correlated with actual stroke volumes determined from cardiac output and heart rate and had a regression line slope close to one. Increases in stroke volume with greater filling pressures resulted from increased ventricular end-diastolic volume with constant end-systolic volume; end-systolic volumes were negligible. Maintenance of stroke volume with increasing output pressure was by increases in both end-diastolic and end-systolic volumes. Decreases in stroke volume with very high output pressures may result from convergence of end-systolic and end-diastolic volumes.

scholarly journals Agreement in Left Ventricular Function Measured by Echocardiography and Cardiac Magnetic Resonance in Patients With Chronic Coronary Total Occlusion

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiahui Li ◽  
Lijun Zhang ◽  
Yueli Wang ◽  
Huijuan Zuo ◽  
Rongchong Huang ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Pearson Correlation ◽  
Left Ventricular ◽  
Lv Function ◽  
Total Occlusion ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
The Difference ◽  
Ventricular Motion

Aims: To determine the agreement between two-dimensional transthoracic echocardiography (2DTTE) and cardiovascular magnetic resonance (CMR) in left ventricular (LV) function [including end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF)] in chronic total occlusion (CTO) patients.Methods: Eighty-eight CTO patients were enrolled in this study. All patients underwent 2DTTE and CMR within 1 week. The correlation and agreement of LVEF, LVESV, and LVEDV as measured by 2DTTE and CMR were assessed using Pearson correlation, Kappa analysis, and Bland–Altman method.Results: The mean age of patients enrolled was 57 ± 10 years. There was a strong correlation (r = 0.71, 0.90, and 0.80, respectively, all P &lt; 0.001) and a moderately strong agreement (Kappa = 0.62, P &lt; 0.001) between the two modalities in measurement of LV function. The agreement in patients with EF ≧50% was better than in those with an EF &lt;50%. CTO patients without echocardiographic wall motion abnormality (WMA) had stronger intermodality correlations (r = 0.84, 0.96, and 0.87, respectively) and smaller biases in LV function measurement.Conclusions: The difference in measurement between 2DTTE and CMR should be noticed in CTO patients with EF &lt;50% or abnormal ventricular motion. CMR should be considered in these conditions.

scholarly journals P908 The novel predictor for mortality in patients with functional mitral regurgitation: the modified MIDA-Score

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Ozturk ◽  
U M Becher ◽  
U M Becher ◽  
A Kalkan ◽  
A Kalkan ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Hazard Analysis ◽  
Strong Predictor ◽  
Cox Proportional Hazard ◽  
Sts Score ◽  
Long Term Prognosis ◽  
Grade 3

Abstract EuroSCORE and STS-Score are used to assess surgical risk in patients with valvular heart diseases. The MIDA- Score has been recently published as a representative predictor for short- and long-term prognosis in patients with degenerative mitral regurgitation (DMR). The adequate assessment of long-term prognosis in patients with functional MR is scarce. We aim to adapt this classical score system for patients with FMR. We retrospectively included 105 patients with FMR who underwent transcatheter mitral regurgitation therapy (TMVR) between January 2014 and August 2016 in our center. Due to the different underlying pathomechanisms of FMR, annular dilatation and impaired left ventricle function, and more elderly patient population we adapted some cut-off values to FMR patients (Age &gt; 65 to Age &gt; 75; LV-EF ≤ 60% to LV-EF ≤ 45%; sPAP≥50mmHg to sPAP≥45mmHg). Moreover, according to Cox proportional hazard analysis of our patient collective we re-calculated the weights of the risk factors: Age 2 points, Symptoms 1 point, atrial fibrillation 2 points, left atrial diameter 1 point, right ventricle systolic pressure 2 points, left ventricle end-systolic diameter 2 points, left ventricle ejection fraction 2 points. We defined three risk groups according to total points from the risk factors; Grade 1 (0-4 points): low risk, Grade 2 (5-9 points): moderate risk, Grade 3 (10-12 points): high risk. We retrospectively included 105 patients (76.7 ± 8.8 years, 50,6% female) with symptomatic (functional NYHA class &gt; II ) moderate-to-severe FMR (PISA: 0.7 ± 0.4cm, VC width: 0.8 ± 0.3cm, EROA: 0.22cm2, RegVol: 38.1 ± 19.2ml) at surgical high risk (EuroSCORE II: 5.4 ± 3.8%, STS-Score: 4.7 ± 2.8%). We found all-cause mortality 7% at one-year follow-up. 34.1% of our collective were hospitalized. The classical MIDA Score was not significantly correlated with mortality and rehospitalization in patients with FMR at follow-up (p = 0.5); however, the modified MIDA score was found to be a strong predictor for mortality and rehospitalization in patients with FMR (AUC: 0.89). According to multivariate analysis, the modified MIDA score was found to be superior compared to the other conventional score systems (The modified MIDA-Score HR: 4.1, p = 0.021; EuroSCORE II; HR: 1.2, p = 0.004, STS-Score; HR: 1.7, p = 0.005). We performed Cox proportional hazard analysis to assess the weighting factor of the predictors. As a result of this, we found age (HR: 2,95, p = 0.03) as the most reliable parameter to predict the combined outcome. The 12,5% of grade 1, 27% grade 2, 57% grade 3 patients showed combined endpoint. According to regression analysis, the modified score &gt;9 points found to be a strong predictor for high mortality and rehospitalization (OR: 3.35, p = 0.011). We found the modified MIDA Score sufficient and extensive to assess outcomes in patients with FMR. The modified MIDA Score offers a sufficient promising tool to predict individual prognosis in patients with FMR.

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