scholarly journals Diagnostic Value of Left Ventricular Early Inflow-Outflow Index in Determining Severity of Mitral Regurgitation

2017 ◽  
pp. 64-71
Author(s):  
Vera Yulia ◽  
Mefri Yanni ◽  
Didik Hariyanto
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Diagnostic Value ◽  
Geometric Error ◽  
Left Ventricular ◽  
Cross Sectional ◽  
Spectral Doppler ◽  
Common Etiology ◽  
Cross Sectional Design ◽  
Sensitivity Specificity

Background: Determining severity of mitral regurgitation (MR) is very important, asit is related with prognosis and management of the disease. Currently, there is no goldstandard exists for quantification of MR severity using echocardiography. AmericanSociety of Echocardiography (ASE) guidelines recommend several parameters basedon integrative criteria using color and spectral Doppler and anatomic measurement.Left Ventricular Early Inflow Outflow Index (LVEIO Index) was proposed as one parameterto assess the severity of MR by omitting geometric error from regurgitantvolume method. Thus, LVEIO index offers a simple, easy and accurate measurementin determining severity of MR.Methods: This study was a diagnostic test research with cross-sectional design. Thesubjects were all patients with organic mitral regurgitation who underwent echocardiographyexamination to measure severity of MR using the LVEIO index as well asother parameters measurements based on parameters of ASE guidelines. Diagnostictest was used to determine the sensitivity, specificity, positive predictive value, negativepredictive value and accuracy of LVEIO index.Results: Of 49 patients in this study, 23 of them have severe MR and 26 are non-severeMR patients. The proportion of gender between two groups almost similar with an agerange from 56 to 61 years and the most common etiology finding was degenerative MR.Echocardiography examination showed the ejection fraction in severe MR was 63±4.2%and 64±3.9% in non-severe MR. The value of LAVI, MPAP, E-wave, VC, EROA andLVEIO index increased parallel with severity of MR (LAVI; 67±18.2 vs. 40±14.2 ml/m2,MPAP; 28±12.8 vs. 20±12.6 mmHg, E-wave 1.5±0.3 vs. 1±0.2 m/s, VC 0.8±0.3 vs.0.5±0.1 cm, EROA 0.4±0.1 vs 0,2±0,1cm2, LVEIO 9±2,4 vs. 5±1,8). The sensitivity,specificity, and accuracy of LVEIO index for diagnosis of severe MR were 86%, 84%,and 89%, respectively.Conclusion: LVEIO can be proposed as a relatively simple, easy and accurate methodin determining severity of MR.

scholarly journals Interval TpTe Diagnostic Value in Diastolic Dysfunction of Patients with Hypertension

2018 ◽  
Vol 3 (2) ◽  
pp. 61
Author(s):  
Rano Irmawan ◽  
Braghmandaru Adhi Bhaskara ◽  
Hasanah Mumpuni ◽  
Nahar Taufiq
Keyword(s):  
Diastolic Dysfunction ◽  
Predictive Value ◽  
Systolic Function ◽  
Diagnostic Value ◽  
Left Ventricular ◽  
Observational Research ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Diastolic Relaxation ◽  
Cross Sectional Design

Introduction: Diastolic dysfunction has been shown to be associated with an increase in mortality rates in both normal and decreased systolic function. In patients with hypertension, there is elongation of transmural repolarization dispersion in left ventricular, which will cause heart diastolic relaxation disorders. The elongation of the transmural repolarization dispersion is indicated by the increase of the TpTe interval. We conducted this study to fnd out whether the TpTe interval had a good diagnostic value in detecting diastolic dysfunction in patients with hypertension.Methods: This is an analytic observational research using cross sectional design on hypertensive patients in whom echocardiography was performed. The study conducted in February 2017 until March 2017 in Dr. Sarjito general hospital Yogyakarta. Electrocardiography examination was taken after the patient was performed echocardiography. The TpTe interval was calculated using the ‘tail’ method at lead V5. Diastolic dysfunction was established using echocardiographywith the ASE / EAE 2016 algorithm.Results: Of the 112 patients met the criteria of the study subjects. The cut-off value for TpTe was 103.97 m.s., based R.O.C curve analysis. TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction with 73% accuracy, 83% sensitivity, 64% specifcity, 22% positive predictive value, and 97% negative predictive value. There were 66 (58.9%) subjectswith TpTe interval <103.97 m.s. and 46 subjects (41.1%) with TpTe interval ≥103.97 m.s. There were 12 subjects (10.7%) with diastolic dysfunction. Bivariate and multivariate analyzes showed no demographic and clinical factors that independently affected the TpTe interval.Conclusion: The TpTe interval ≥ 103.97 m.s. had a moderate diagnostic value for detecting diastolic dysfunction in patients with hypertension

Outcomes of surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children

2021 ◽  
pp. 1-6
Author(s):  
Tong Feng ◽  
Guo Zhangke ◽  
Bai Song ◽  
Fan Fan ◽  
Zhen Jia ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Pulmonary Artery ◽  
Left Coronary Artery ◽  
Surgical Repair ◽  
Left Ventricular ◽  
Anomalous Origin ◽  
Dimension Index

Abstract Objectives: Anomalous origin of the left coronary artery from the pulmonary artery is associated with high mortality if not timely surgery. We reviewed our experience with anomalous origin of the left coronary artery from the pulmonary artery to assess the preoperative variables predictive of outcome and post-operative recovery of left ventricular function. Methods: A retrospective review was conducted and collected data from patients who underwent anomalous origin of the left coronary artery from the pulmonary artery repair at our institute from April 2005 to December 2019. Left ventricular function was assessed by ejection fraction and the left ventricular end-diastolic dimension index. The outcomes of reimplantation repair were analysed. Results: A total of 30 consecutive patients underwent anomalous origin of the left coronary artery from the pulmonary artery repair, with a median age of 14.7 months (range, 1.5–59.6 months), including 14 females (46.67%). Surgery was performed with direct coronary reimplantation in 12 patients (40%) and the coronary lengthening technique in 18 (60%). Twelve patients had concomitant mitral annuloplasty. There were two in-hospital deaths (6.67%), no patients required mechanical support, and no late deaths occurred. Follow-up echocardiograms demonstrated significant improvement between the post-operative time point and the last follow-up in ejection fraction (49.43%±19.92% vs 60.21%±8.27%, p < 0.01) and in moderate or more severe mitral regurgitation (19/30 vs 5/28, p < 0.01). The left ventricular end-diastolic dimension index decreased from 101.91 ± 23.07 to 65.06 ± 12.82 (p < 0.01). Conclusions: Surgical repair of anomalous origin of the left coronary artery from the pulmonary artery has good mid-term results with low mortality and reintervention rates. The coronary lengthening technique has good operability and leads to excellent cardiac recovery. The decision to concomitantly correct mitral regurgitation should be flexible and be based on the pathological changes of the mitral valve and the degree of mitral regurgitation.

scholarly journals Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation

2021 ◽  
Vol 10 (14) ◽  
pp. 3013
Author(s):  
Juyoun Kim ◽  
Jae-Sik Nam ◽  
Youngdo Kim ◽  
Ji-Hyun Chin ◽  
In-Cheol Choi
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular Dysfunction ◽  
Predictive Value ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Lvef

Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.

scholarly journals The Sensitivity and Specificity of Chicago Sky Blue (CSB) Dye in Comparisson with Potassium Hydroxide (KOH) Method for Superficial Dermatomycosis

2020 ◽  
Vol 16 (2) ◽  
pp. 155
Author(s):  
Amalia Nadiasari ◽  
Diana Tri Ratnasari ◽  
Masfufatun Masfufatun
Keyword(s):  
Sensitivity And Specificity ◽  
Potassium Hydroxide ◽  
Pityriasis Versicolor ◽  
Color Contrast ◽  
Research Subjects ◽  
Cross Sectional ◽  
Proper Diagnosis ◽  
Cross Sectional Design ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Abstract: Superficial dermatomycosis is a skin, nail and hair infection caused by fungal pathogen. Based on the pathogen, this infection can be divided into dermatophytosis, pityriasis versicolor and superficial candidiasis. The rapid and proper diagnosis is necessary to determine the initial theraphy and prevent the treatment delay. Superficial dermatomycosis diagnosis can be performed using anamnesis, physical examination or supporting investigation. The routine investigation method commonly use Potassium Hydroxide (KOH) because the KOH method is easy to be performed, rapid, simple and affordable. Chicago Sky Blue (CSB) is a dye to give a better color contrast to the fungi so the fungi would be easier to be detected. Objectives of this research is to observe the sensitivity and specifity difference of Chicago Sky Blue (CSB) dye and Potassium Hydroxide (KOH) methods for Superficial Dermatomycosis. The research was performed using cross sectional design analitical obsevation with 30 research subjects. The subjects consist of 15 superficial dermatomycosis patients and 15 non-superficial dermatomycosis patients. The samples were taken from the patients lesion swabs. The samples were checked using KOH and CSB, then observed by the medical analyst. The superficial dermatomycosis samples consist of mostly dermathophytosis (53.33%), then pityriasis versicolor (26.67%) and superficial candidiasis (20%). The sensitivity and specificity of KOH were 86.67% and 100%, respectively. The sensitivity and specificity of CSB were 93.33% and 100%, respectively. The CSB dye method has a higher sensitivity than KOH. The fungal elements are nicely dyed and more easily detected using CSB dye.  Keywords: KOH, Chicago Sky Blue, sensitivity, specificity, superficial dermatomycosis

Abstract 2066: Does Mitral Regurgitation Regress After Aortic Valve Replacement For Aortic Stenosis ? A Prospective Multicenter Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Philippe Unger ◽  
Danièle Plein ◽  
Bernard Cosyns ◽  
Guy Van Camp ◽  
Olivier Xhaët ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Regurgitant Volume ◽  
Lv Ejection Fraction

Background: Mitral regurgitation (MR) is common in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). Whether its severity may decrease after AVR remains controversial. Previous studies were mainly retrospective and the degree of MR was assessed at best semi-quantitatively. This study sought to prospectively and quantitatively assess how AVR may affect MR severity. Methods: Patients with AS scheduled for isolated AVR and presenting holosystolic MR which was not considered for replacement or repair were included. Previous mitral valve surgery; severe aortic regurgitation and poor acoustic windows were excluded. Thirty-five patients (mean age 77±7 years) were studied before (median 1, range 1– 41 days) and after AVR (median 7, range 4 –19 days). All patients underwent a comprehensive echocardiographic examination; MR was assessed by Doppler echocardiography using color flow mapping of the regurgitant jet and the PISA method. No patient had prolapsed or flail mitral leaflet as mechanism of MR. Results: Preoperative maximal and mean transaortic pressure gradients and aortic valve area were 74±26 mmHg, 44±16 mmHg, and 0.57±0.18 cm 2 , respectively. Left ventricular (LV) ejection fraction increased from 49±16 % to 55±15 % after AVR (p<0.001). LV end-diastolic volume decreased from 91±32 ml to 77±30 ml (p<0.001).The ratio of MR jet to left atrial area decreased from 30±16% to 20±14% (p<0.001). MR effective regurgitant orifice (ERO) and regurgitant volume decreased from 10±5 mm 2 to 8±6 mm 2 (p=0.015) and from 19±10 ml to 11±9 ml (p<0.0001). The decrease in ERO and in regurgitant volume was similar in patients with preserved or depressed LV ejection fraction (≤45 %) (2±3 vs 3±6 mm 2 and 7±9 vs 8±7 ml; p=NS, respectively). Conclusions: AVR is associated with an early postoperative reduction of the quantified degree of MR. This mainly results from a decrease in regurgitant volume and only modestly from a reduction in ERO, emphasizing the contributing role of the decrease in driving pressure accross the mitral regurgitant orifice.

scholarly journals 559 An analysis of myocardial efficiency in patients with severe asymptomatic mitral regurgitation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Cetin Guvenc ◽  
E Arugaslan ◽  
T S Guvenc ◽  
F Ozpamuk Karadeniz ◽  
H Kasikcioglu ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Severe Mitral Regurgitation ◽  
External Work ◽  
Ventricular Ejection Fraction ◽  
Myocardial Efficiency

Abstract Funding Acknowledgements None declared. Background and Aims It is difficult to determine left ventricular systolic performance in patients with severe mitral regurgitation (MR) since left ventricular ejection fraction (EF) could be preserved until the end stages of the disease. Myocardial efficiency describes the amount of external work (EW) done by the left ventricle per unit of oxygen consumed (mVO2). In the present study, we aimed to investigate MEf in patients with asymptomatic severe MR using a novel echocardiographic method. Methods: A total of 27 patients with severe asymptomatic MR and 26 healthy volunteers were included in this cross-sectional study. EW was measured using stroke volume and blood pressure, while mVO2 was estimated using double product and LV mass. Results: There were no differences between the groups with regards to EF (66%±5% vs. 69%±7%), while MEf was significantly reduced in patients with severe MR (25%±11% vs. 44%±12%, p &lt; 0.001) (Table 1). This difference was maintained even after adjustment for age, gender and body surface area (adjusted :0.44, 95%CI: 0.39–0.49 for controls and adjusted :0.24, 95%CI: 0.19–0.29 for patients with severe MR). Further analysis showed that this reduction was due to an increase in total mVO2 in the severe MR group (Figure 1). Conclusions: Myocardial efficiency was significantly lower in patients with asymptomatic severe MR and preserved EF. Table 1 Parameter Control Group (n = 26) Severe Mitral Regurgitation (n = 27) P Value Age (y) 36.5 ± 8.9 41.3 ± 14.2 0.23 Gender (%Male) 9 (35%) 10 (37%) 1.0 BSA (m2) 1.82 ± 0.20 1.76 ± 0.18 0.64 LV End-Diastolic Volume (ml) 83.13 ± 18.88 121.91 ± 37.63 &lt;0.001 LV End-Systolic Volume (ml) 28.07 ± 9.57 45.30 ± 17.42 &lt;0.001 Left Ventricular Ejection Fraction (%) 0.69 ± 0.07 0.66 ± 0.05 0.29 Systolic Mitral Velocity (cm/s) 7.88 ± 1.14 8.07 ± 1.81 0.66 Stroke Work (j) 1.14 ± 0.21 1.15 ± 0.36 0.91 Minute External Work (j) 65.96 ± 14.71 70.17 ± 23.15 0.85 mVO2 (ml.min-1.100g-1) 6.79 ± 1.93 9.48 ± 4.71 0.02 Total mVO2 (j) 166.58 ± 77.14 346.46 ± 202.71 &lt;0.001 Myocardial Efficiency (%) 44 ± 12 25 ± 11 &lt;0.001 Table 1. Demographic, anthropometric, echocardiographic and mechanoenergetic data for study groups. BSA, body surface area; LV, left ventricle; mVO2, myocardial oxygen consumption. Abstract 559 Figure 1

scholarly journals Can We Predict Failure of Mitral Valve Repair?

2019 ◽  
Vol 8 (4) ◽  
pp. 526 ◽  
Author(s):  
Simone Gasser ◽  
Maria von Stumm ◽  
Christoph Sinning ◽  
Ulrich Schaefer ◽  
Hermann Reichenspurner ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Mitral Valve Repair ◽  
Mitral Valve Surgery ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Redo Surgery ◽  
Valve Repair

Objective: To identify echocardiographic and surgical risk factors for failure after mitral valve repair. Methods: We identified a total of 77 consecutive patients from our institutional mitral valve surgery database who required redo mitral valve surgery due to recurrence of mitral regurgitation after primary mitral valve repair. A control group of 138 patients who had a stable echocardiographic long-term result was included based on propensity score matching. Systematic analysis of echocardiographic parameters was performed before primary surgery; after mitral valve repair and prior to redo surgery. Risk factor analysis was performed using multivariate Cox regression model. Results: Redo surgery was associated with the presence of pulmonary hypertension ≥ 50 mmHg (p = 0.02), a mean transmitral gradient > 5 mmHg (p = 0.001), left ventricular ejection fraction ≤ 45% (p = 0.05) before surgery and mitral regurgitation ≥moderate at time of discharge (p = 0.002) in the whole cohort. Patients with functional mitral valve regurgitation had a higher tendency to undergo redo surgery if preoperative left ventricular end-diastolic diameter exceeded 65 mm (p = 0.043) and if postoperative tenting height exceeded 6 mm (p = 0.018). Low ejection fraction was not significantly associated with the need for redo mitral valve surgery in the functional subgroup. Conclusions: Recurrent mitral regurgitation is still a valuable problem and is associated with relevant perioperative mortality. Patients with severe mitral regurgitation should undergo early mitral valve repair surgery as long as systolic pulmonary artery pressure is low, left ventricular ejection fraction is preserved, and LVEED is deceeds 65 mm.

Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure

2011 ◽  
Vol 19 (3) ◽  
pp. 396-403 ◽  
Author(s):  
Gabriella Malfatto ◽  
Giovanna Branzi ◽  
Alessia Giglio ◽  
Francesca Ciambellotti ◽  
Alessandra Villani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Diastolic Dysfunction ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Filling Pattern

Background: Heart failure is increasing in the elderly and represents a socioeconomic burden requiring the correct management for which risk stratification is mandatory. Among younger patients, echocardiogram and cardiopulmonary exercise test are useful in prognostic stratification. Few studies have analyzed the utility of these tests in elderly patients. Methods: We report on 90 patients over 70 years old, on whom cardiopulmonary tests and echocardiograms were performed between 1998 and 2006 (67 M, 23 F; 75 ± 3 years; ejection fraction (EF) 30 ± 6%; NYHA 2.1 ± 0.8; 60% ischemic; therapy according to international guidelines). Echocardiographic variables were (1) left ventricular ejection fraction (EF); (2) severity of diastolic dysfunction on multiparametric examination of Doppler and TDI parameters; (3) severity of functional mitral regurgitation. Cardiopulmonary variables were (1) peak VO2; (2) peak O2 pulse; (3) peak respiratory quotient (RQ); (4) VE/VCO2 slope. Endpoint considered was mortality of any cause at three-years follow-up. Results: Mortality was 21%. At univariate analysis, survivors ( n = 71) and deceased ( n = 19) were similar for age, NYHA class, peakVO2 and RQ; they differed for EF, severity of mitral regurgitation, severity of diastolic dysfunction, O2 pulse and VE/VCO2 slope. At multivariate analysis, only VE/VCO2 slope and severe diastolic dysfunction (restrictive filling pattern) discriminated between the two groups. In particular, the association of restrictive filling pattern and VE/VCO2 slope ≥ 45 predicted 3-year mortality with sensitivity of 84% and specificity of 88%. Conclusions: Echocardiographic and cardiopulmonary data can identify high-risk elderly patients with systolic heart failure, who may need aggressive clinical management.

Sign in / Sign up

Export Citation Format

Share Document