scholarly journals Pathogenesis of Mitral Regurgitation in Tachycardia-Induced Cardiomyopathy

Circulation ◽  
2001 ◽  
Vol 104 (suppl_1) ◽  
Author(s):  
Tomasz A. Timek ◽  
Paul Dagum ◽  
David T. Lai ◽  
David Liang ◽  
George T. Daughters ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Dilated Cardiomyopathy ◽  
Transesophageal Echocardiography ◽  
Angular Displacement ◽  
Mitral Annulus ◽  
Valve Closure ◽  
Lateral Direction ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Tachycardia Induced Cardiomyopathy

Background Dilated cardiomyopathy is often associated with mitral regurgitation (MR), or so-called functional MR, the mechanism of which continues to be debated. We studied the valvular and ventricular 3D geometric perturbations associated with MR in an ovine model of tachycardia-induced cardiomyopathy (TIC). Methods and Results Nine sheep underwent myocardial marker implantation in the left ventricle (LV), mitral annulus, and mitral leaflets. After 5 to 8 days, the animals were studied with biplane videofluoroscopy (baseline), and mitral competence was assessed by transesophageal echocardiography. Rapid ventricular pacing (180 to 230 bpm) was subsequently initiated for 15±6 days until the development of TIC and MR, whereupon biplane videofluoroscopy and transesophageal echocardiography studies were repeated. LV volume was calculated from the epicardial marker array. Valve closure time was defined as the time after end diastole when the distance between leaflet edge markers reached its minimal plateau. TIC resulted in increased LV end-diastolic volume ( P =0.001) and LV end-systolic volume ( P =0.0001) and greater LV sphericity ( P =0.02). MR increased significantly (grade 0.2±0.3 versus 2.2±0.9, P =0.0001), as did mitral annulus area (817±146 versus 1100±161 mm 2 , P =0.0001) and mitral annulus septal-lateral diameter (28.2±3.5 versus 35.1±2.6 mm, P =0.0001). Time of valve closure (70±18 versus 87±14 ms, P =0.23) and angular displacement of both the anterior (29±5° versus 27±3°, P =0.3) and posterior (55±15° versus 44±11°, P =0.13) leaflet edges relative to the mitral annulus after valve closure did not change, but leaflet edge separation after closure increased (5.2±0.9 versus 6.8±1.2 mm, P =0.019). Conclusions MR in TIC resulted from decreased leaflet coaptation secondary to annular dilatation in the septal-lateral direction. These data support the use of annular reduction procedures, such as rigid, complete ring annuloplasty, to address functional MR in patients with dilated cardiomyopathy.

P6348Phospholamban antisense oligonucleotides drive the reversal of cardiac dysfunction and multiple heart failure parameters during murine dilated cardiomyopathy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Spaeter ◽  
A Hidalgo Gonzalez ◽  
Z Elbeck ◽  
S T Yeh ◽  
H Siga ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Function ◽  
Dilated Cardiomyopathy ◽  
Transcriptome Profiling ◽  
Bioinformatic Analysis ◽  
Systolic Volume ◽  
Genetic Ablation ◽  
Gene Therapy Approach ◽  
End Diastolic Volume

Abstract Background Mice lacking muscle LIM protein (Mlp/Cspr3 −/−) develop dilated cardiomyopathy (DCM). Previous work established this model to be amenable to improvements in cardiac function by genetic ablation of phospholamban (PLN). Purpose To test the hypothesis that therapeutic reductions of PLN would similarly improve cardiac function, Mlp KO mice were administered an antisense oligonucleotide (ASO) targeting PLN. Methods Echocardiography measurements of ejection fraction (EF), end-diastolic volume (EDV) and end-systolic volume (ESV) were performed before and after treatment. In addition, global transcriptome profiling using 3'RNA-seq was performed to identify gene expression changes in diseased Mlp KO mice and following PLN ASO treatments. Mlp KO mice with ejection fraction (EF%) of less than 45% (median, 37.6%; interquartile range, 32.2–42.0%) were treated with vehicle (n=10) or PLN ASO (n=9) for 4 weeks. Results Three subcutaneous injections of PLN ASO were administered to Mlp KO mice resulting in 50–70% PLN reductions. Echocardiography performed at study end revealed improvements of EF (60±8 vs. 46±12%), ESV (31±11 vs. 56±21μl) and EDV (79±22 vs. 100±25μl) with PLN ASO treatment. Corrected for baseline values, PLN ASO treatment improved all echocardiographic measurements (p<0.001). Transcriptional analyses revealed that PLN ASO treatment reduced expression of heart failure related markers, such as Myh7 (−70%), Nppa (−72%), Nppb (−71%), Acta1 (−84%) and Ankrd1 (−40%), p<0.05 vs. vehicle. In addition, genes not previously known to be dysregulated in this model, Edn3 and Xirp2, were identified and shown to be reduced following PLN ASO treatment by 71% and 67%, respectively (p<0.001). Bioinformatic analysis suggested improvement of known and novel heart failure associated pathways by PLN inhibition in this model. In conclusion, antisense inhibition of PLN reduced functional and transcriptional indices of heart failure in a DCM model. In view of the failed CUPID trials, a gene therapy approach to improve SERCA2a activity, targeting PLN with ASO may be advantageous due to a likely more robust pharmacological profile.

Motion of both mitral valve leaflets: a cineroentgenographic study in intact dogs

1975 ◽  
Vol 39 (3) ◽  
pp. 359-366 ◽  
Author(s):  
A. G. Tsakiris ◽  
D. A. Gordon ◽  
Y. Mathieu ◽  
L. Irving
Keyword(s):  
Heart Rate ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Annulus ◽  
Valve Closure ◽  
Time Motion ◽  
Intraventricular Flow ◽  
Radiopaque Markers ◽  
Posterior Cusp ◽  
Opening And Closing

Motion and position of both mitral leaflets were studied in five normal dogs 1–11 wk after radiopaque markers were sutured on the valve cusps and on the mitral annulus. Cinefluorograms and cineangiograms (100–120 frames/s) of left atrium and left ventricle were used to study cusp motion and intraventricular flow patterns, and to detect mitral regurgitation during sinus rhythm (42–184 beats/min) and during isolated atrial or ventricular contractions. Time-motion of both leaflets was similar throughout diastole with the exception of delayed posterior cusp opening. Peak opening and closing speeds, opening and closing times, and time of complete closure, measured from the Q wave of the ECG, were not significantly affected by the variations in heart rate. Diastolic leaflet closure began immediately after opening, while the ventricular cavity was small, and was caused by flow eddies behind the cusps. Isolated ventricular contractions closed the valve leaflets completely and symmetric valve closure was ensured by the different rates of leaflet edge approximation. In contrast, atrial closure was slow, partial, and of very short duration.

Atrial contraction and mitral annular dynamics during acute left atrial and ventricular ischemia in sheep

2002 ◽  
Vol 283 (5) ◽  
pp. H1929-H1935 ◽  
Author(s):  
Tomasz A. Timek ◽  
David T. Lai ◽  
Frederick Tibayan ◽  
George T. Daughters ◽  
David Liang ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Left Atrial ◽  
Contractile Function ◽  
Mitral Annulus ◽  
Balloon Occlusion ◽  
Valve Closure ◽  
Area Reduction ◽  
Atrial Contraction ◽  
Radiopaque Markers

In six sheep, radiopaque markers were placed on the left ventricle (LV), the mitral annulus, the left atrium (LA), and the central edge of both mitral leaflets to investigate the effects of acute LV ischemia on atrial contraction, mitral annular area (MAA), and mitral regurgitation (MR). Animals were studied with biplane videofluoroscopy and transesophageal echocardiography before and during balloon occlusion of the left anterior descending (LAD), distal circumflex (dLCX), and proximal circumflex (pLCX) coronary arteries. MAA and LA area were calculated from the corresponding markers. LAD occlusion did not alter LA area reduction or presystolic MAA reduction, whereas dLCX occlusion resulted in a mild decrease in the former with no change in the latter. Neither occlusion resulted in MR. pLCX occlusion, however, significantly decreased LA area and presystolic MAA reduction and resulted in increased end-diastolic MAA, delayed valve closure from end diastole, and MR. Decreased atrial contractile function, as observed during acute posterolateral ischemia, is linked to diminished presystolic mitral annular reduction, a larger mitral annular size at end diastole, and MR.

Abstract 17388: Cardiac MRI Derived Forward Stroke Energy is a Better Index of Left Ventricular Pump Function over Ejection Fraction in Mitral Regurgitation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kanika Kalra ◽  
Muralidhar Padala
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Wall Thickening ◽  
Ventricular Contraction ◽  
Plane Flow ◽  
Systolic Volume ◽  
Forward Stroke ◽  
End Diastolic Volume ◽  
Significant Difference

Introduction: Mitral regurgitation (MR) into the low impedance left atrium (LA) enables a pop off valve effect and enables a false low end-diastolic volume and increased ejection fraction (EF). EF in these patients seems falsely high even though their ventricular contraction seems impaired, thus better indices that represent ventricular contraction are required in this lesion. Hypothesis: In this study we sought to investigate if forward stroke energy (FSE), which represents the forward kinetic energy of the blood through the aortic valve is a better indicator of ventricular contraction than EF. Methods: Phase-contrast MRI was performed in patients with MR (n=63; Mild MR =23; Moderate-severe MR=40), at the aortic and mitral valve planes, to compute the transvalvular through-plane flow. EF was measured as ((end-diastolic volume- end systolic volume)/end-diastolic volume), and FSE as (forward aortic stroke volume X mean arterial pressure). LV contractility was computed as the dynamic myocardial wall thickening over the cardiac cycle. Results: Regional peak wall thickening was significantly reduced in the moderate-severe MR groups - equatorial sector (5.9±0.6mm vs. 4.3±0.4mm, p=0.02) and apical sector (6.4±0.5mm vs. 4.5±0.3mm, p=0.003), indicating LV dysfunction with higher MR severity. EF did not capture this difference in LV contraction between the groups (50.1±3.7% vs. 48.3±3.2%, p=0.72). However, FSE demonstrated a significant difference between the two groups and a significant negative correlation (6527±483 mmHg.mL vs. 4895±282 mmHg.mL, p=0.002, r(MRfraction)=-0.42, p=0.0007). Conclusions: Forward stroke energy may better capture reduced myocardial contractility in the setting of MR, than EF - the current clinical gold standard.

scholarly journals Relation of Mitral Annulus and Left Atrial Dysfunction to the Severity of Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Sorina Mihaila Baldea ◽  
Denisa Muraru ◽  
Marcelo Haertel Miglioranza ◽  
Sabino Iliceto ◽  
Dragos Vinereanu ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Dilated Cardiomyopathy ◽  
Three Dimensional ◽  
Mitral Annulus ◽  
Functional Mitral Regurgitation ◽  
Contractile Dysfunction ◽  
Left Atrial Dysfunction ◽  
The Relationship ◽  
Selection Of Patients ◽  
Selection Of

Introduction and Objectives. Patients with dilated cardiomyopathy (DCM) and functional mitral regurgitation (FMR) present altered geometry and dynamics of the mitral annulus (MA). We aimed to further assess the relationship between the MA dysfunction, FMR severity, and LA dysfunction in patients with ischemic and nonischemic DCM by using three-dimensional transthoracic echocardiography (3DTTE). Methods. 56 patients (58 ± 17 years, 42 men) with DCM and FMR and 52 controls, prospectively enrolled, underwent 3DTTE dedicated for mitral valve (MV), LA, and left ventricle (LV) quantitative analysis. Results. Patients with FMR vs. controls presented increased MA size and sphericity during the entire systole, whereas MA fractional area change (MAFAC) and MA displacement were decreased (15 ± 5 vs. 28 ± 5%; and 5 ± 3 vs. 10 ± 2 mm, p<0.001). In patients with moderate/severe FMR, MA diameters correlated with PISA radius, EROA, and regurgitant volume (Rvol), as also did the MA area (with PISA radius, EROA, and Rvol: r = 0.48, r = 0.58, and r = 0.47, p<0.05). MAFAC correlated inversely with EROA and Rvol (r = −0.32 and r = −0.35, p<0.05), with both active and total LA emptying fractions and with LV ejection fraction as well. In a stepwise multivariate regression model, decreased MAFAC and increased LA volume independently predicted patients with severe FMR. Conclusions. Patients with DCM and FMR have MA geometry remodeling and contractile dysfunction, correlated with the severity of FMR. MA contractile dysfunction correlated with both LA and left LV pumps dysfunctions and predicted patients with severe FMR. Our results provide new insights that might help with better selection of patients for MV transcatheter procedures.

scholarly journals Association between right ventricular strain and outcomes in patients with dilated cardiomyopathy

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317949 ◽  
Author(s):  
Tong Liu ◽  
Yifeng Gao ◽  
Hui Wang ◽  
Zhen Zhou ◽  
Rui Wang ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Major Adverse Cardiovascular Events ◽  
Prognostic Impact ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Right Ventricular Strain

ObjectiveTo explore the association between three-dimensional (3D) cardiac magnetic resonance (CMR) feature tracking (FT) right ventricular peak global longitudinal strain (RVpGLS) and major adverse cardiovascular events (MACEs) in patients with stage C or D heart failure (HF) with non-ischaemic dilated cardiomyopathy (NIDCM) but without atrial fibrillation (AF).MethodsPatients with dilated cardiomyopathy were enrolled in this prospective cohort study. Comprehensive clinical and biochemical analysis and CMR imaging were performed. All patients were followed up for MACEs.ResultsA total of 192 patients (age 53±14 years) were eligible for this study. A combination of cardiovascular death and cardiac transplantation occurred in 18 subjects during the median follow-up of 567 (311, 920) days. Brain natriuretic peptide, creatinine, left ventricular (LV) end-diastolic volume, LV end-systolic volume, right ventricular (RV) end-diastolic volume and RVpGLS from CMR were associated with the outcomes. The multivariate Cox regression model adjusting for traditional risk factors and CMR variables detected a significant association between RVpGLS and MACEs in patients with stage C or D HF with NIDCM without AF. Kaplan-Meier analysis based on RVpGLS cut-off value revealed that patients with RVpGLS <−8.5% showed more favourable clinical outcomes than those with RVpGLS ≥−8.5% (p=0.0037). Subanalysis found that this association remained unchanged.ConclusionsRVpGLS-derived from 3D CMR FT is associated with a significant prognostic impact in patients with NIDCM with stage C or D HF and without AF.

Dilated Cardiomyopathy of Becker-Type Muscular Dystrophy with Exon 4 Deletion

Angiology ◽  
2001 ◽  
Vol 52 (5) ◽  
pp. 343-347 ◽  
Author(s):  
Masao Saotome ◽  
Yuji Yoshitomi ◽  
Shunichi Kojima ◽  
Morio Kuramochi
Keyword(s):  
Muscular Dystrophy ◽  
Dilated Cardiomyopathy ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Skeletal Muscle Biopsy ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Exon 4

The authors report a 47-year-old man with Becker-type muscular dystrophy presenting with dilated cardiomyopathy. Left ventriculography showed diffuse severe hypokinesia: left ventric ular end-diastolic volume index 193 mL/m2, left ventricular end-systolic volume index 143 mL/m 2, and left ventricular ejection fraction 26%. Skeletal muscle biopsy demonstrated a dystrophic process. Genetic analysis revealed a deletion of exon 4. There was a difference in immunos taining pattern between skeletal muscles and cardiac muscles. Severe cardiac dysfunction in this case may be associated with the damage in dystrophin-deficient fibers.

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&lt;0.03), EROA during exercise (the cut-off value 0.37 cm2, the area 0.86, p&lt;0.0003), regurgitant volume during stress (the cut-off value 82 ml, the area 0.79, p&lt;0.02), the difference between stress and rest B-lines (the cut-off value 6 lines, the area 0.83, p&lt;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.

scholarly journals Fully automated software for mitral annulus evaluation in chronic mitral regurgitation by 3-dimensional transesophageal echocardiography

Medicine ◽  
2016 ◽  
Vol 95 (49) ◽  
pp. e5387 ◽  
Author(s):  
Iolanda Aquila ◽  
Covadonga Fernández-Golfín ◽  
Luis Miguel Rincon ◽  
Ariana González ◽  
Ana García Martín ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Transesophageal Echocardiography ◽  
Mitral Annulus ◽  
3 Dimensional ◽  
Automated Software

scholarly journals Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient?

2020 ◽  
Vol 23 (3) ◽  
pp. E370-E375
Author(s):  
Hunbo Shim ◽  
Ji-won Hwang ◽  
Won-Sang Chung ◽  
Chun Ki Kim ◽  
Byung Jo Park ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Mitral Annulus ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Reverse Remodeling ◽  
Systolic Volume ◽  
One Year

Background: The progress of mild ischemic mitral regurgitation (MR) after isolated coronary artery bypass is not clear. We aimed to determine the proportion of patients with mild ischemic MR undergoing isolated coronary artery bypass grafting (CABG) presenting with regression of or persistent MR one year after CABG and to identify the significantly different echocardiographic variables between regressing and persistent MR. Methods: Sixty-three patients with preoperative mild ischemic MR were categorized into an MR-regression or an MR-persistence group one year after isolated CABG. The echocardiographic indices, indicating mitral leaflet configuration and remodeling of the left ventricle (LV), were measured before and one year after the surgery. Results: One year after CABG, MR regressed in 60% (38/63) and persisted in 40% (25/63) of the patients. The left ventricular diameter, volume, and sphericity and anteroposterior diameter of the mitral annulus improved only in the MR-regression group, while the ejection fraction improved in both groups (47.7% ± 12.4% from 40.1% ± 11.3%, P < .001 in the regression group and 43.2% ± 14.0% from 39.3% ± 11.6%, P = .035 in the persistence group). A >15% decrease in the LV end-systolic volume was noted more frequently in the MR-regression group (60.5% versus 30%, P = .027). The leaflet angle did not show asymmetry or significant changes in both groups. Conclusions: Isolated CABG improved mild MR in most patients with mild ischemic MR. These patients showed greater reverse remodeling after revascularization than the patients with persistent MR after isolated CABG. Additional tests, which can predict LV reverse remodeling, are needed to predict persistent MR.

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