Depressed myocardial contractility in mitral stenosis. An analysis by force-length and stress-shortening relationships.

Kaku, Kiyotaka; Hirota, Yuzo; Shimizu, Gen; Kita, Yoshio; Saito, Takaharu; Kawamura, Keishiro

doi:10.1253/jcj.52.35

Cited by 8 publications

(5 citation statements)

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“…In the 1950s, studies by Harvey 1 and Fleming 2 explored mechanistic theories related to the presentation of depressed LV function in MS. Surgical commissurotomy was widely considered as an effective therapy to relieve symptoms at that time, and the ability to distinguish patients with mechanical obstruction that may benefit from surgery from those with primary myocardial insufficiency held clinical and prognostic relevance. Several studies have subsequently reported reduced pump performance in this setting 3‐8 and have attributed this to variable mechanisms that include impaired LV filling secondary to mitral valvular obstruction, 9‐11 chronic myocardial inflammation, 12‐14 sub‐valvular scarring resulting in regional abnormalities, 3,15,16 elevated systemic load, 4,17‐19 and right–left interactions 20 (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Left ventricular diastolic function in mitral stenosis

Venkateshvaran

Govind

2020

Echocardiography

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The assessment of left ventricular (LV) function in the setting of mitral stenosis (MS) has been critically examined for decades. Accurate assessment of aberrations in diastolic function is important as these subjects often present with signs and symptoms of heart failure and pulmonary congestion that cannot be solely explained by the severity of mechanical obstruction. Echocardiographic evaluation of diastolic dysfunction includes an evaluation of reduced LV compliance, diminished restoring forces, and enhanced stiffness, which are challenging in the setting of MS owing to altered hemodynamic loading. Conventional echocardiographic and Doppler measures offer limited information. Novel assessments employing speckle tracking echocardiography are relatively less studied. A more comprehensive assessment including clinical evaluation, identification of concomitant disorders, and comorbidities is particularly warranted in older subjects with degenerative MS to suspect diastolic dysfunction and arrive at optimal medical therapy or intervention. This review provides an overview of etiological, pathophysiological, echocardiographic, and invasive assessment of diastolic dysfunction in the setting of MS, with specific focus on strengths and limitations of available echocardiographic and Doppler techniques.

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Section: Introductionmentioning

confidence: 99%

Left ventricular diastolic function in mitral stenosis

Venkateshvaran

Govind

2020

Echocardiography

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“…; Kaku et al . ). Indeed, based on the analysis of indices such as EF, stroke work as well as ESPVR and wall motion scoring, earlier studies reported evidence of impaired LV function in MS patients (Heller & Carleton ; Curry et al .…”

Section: Discussionmentioning

confidence: 97%

“…LV performance in rheumatic MS has been an issue of debate with conflicting observations that might partly be attributed to the load susceptibility of the various measurements employed for the quantification of LV function (Ahmed et al 1977;Kaku et al 1988). Indeed, based on the analysis of indices such as EF, stroke work as well as ESPVR and wall motion scoring, earlier studies reported evidence of impaired LV function in MS patients (Heller & Carleton 1970;Curry et al 1972;Hildner et al 1972).…”

Section: Discussionmentioning

confidence: 99%

“…) and chronic LV under‐filling (Kaku et al . ). However, later investigations challenged this notion, revealing normal LV contractility in pure MS (Gash et al .…”

Section: Introductionmentioning

confidence: 97%

“…Despite numerous attempts to characterize left ventricular (LV) systolic function in the setting of mitral stenosis (MS), current evidence remains largely conflicting. Early studies demonstrated impaired LV systolic performance, ascribing this to mechanisms such as myocardial fibrosis (Sunamori et al 1983), impaired inter-ventricular interaction (Curry et al 1972) and chronic LV under-filling (Kaku et al 1988). However, later investigations challenged this notion, revealing normal LV contractility in pure MS (Gash et al 1983;Liu et al 1992).…”

Section: Introductionmentioning

confidence: 99%

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The impact of arterial load on left ventricular performance: an invasive haemodynamic study in severe mitral stenosis

Venkateshvaran

Sola

Govind

et al. 2015

The Journal of Physiology

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Key pointsr A hallmark of mitral stenosis (MS) is the markedly altered left ventricular (LV) loading. r As most of the methods used to determine LV performance in MS patients are influenced by loading conditions, previous studies have shown conflicting results.r The present study calculated LV elastance, which is a robust method to quantify LV function.We demonstrate that LV loading in MS patients is elevated but normalizes after valve repair and might be a result of reflex pathways.r Additionally, we show that the LV in MS is less compliant than normal due to a combination of right ventricular loading and the valvular disease itself. Immediately after valve dilatation the increase in blood inflow into the LV results in even greater LV stiffness.r Our findings enrich our understanding of heart function in MS patients and provide a simple reproducible way of assessing LV performance in MS.Abstract Left ventricular (LV) function in rheumatic mitral stenosis (MS) remains an issue of controversy, due to load dependency of previously employed assessment methods. We investigated LV performance in MS employing relatively load-independent indices robust to the altered loading state. We studied 106 subjects (32 ± 8 years, 72% female) with severe MS (0.8 ± 0.2 cm 2 ) and 40 age-matched controls. MS subjects underwent simultaneous bi-ventricular catheterization and transthoracic echocardiography (TTE) before and immediately after percutaneous transvenous mitral commisurotomy (PTMC). Sphygmomanometric brachial artery pressures and TTE recordings were simultaneously acquired in controls. Single-beat LV elastance (E es ) was employed for LV contractility measurements. Effective arterial elastance (E a ) and LV diastolic stiffness were measured. MS patients demonstrated significantly elevated afterload (E a : 3.0 ± 1.3 vs. 1.5 ± 0.3 mmHg ml −1 ; P < 0.001) and LV contractility (E es : 4.1 ± 1.6 vs. 2.4 ± 0.5 mmHg ml −1 ; P < 0.001) as compared to controls, with higher E a in subjects with smaller mitral valve area (ࣘ 0.8 cm 2 ) and pronounced subvalvular fusion. Stroke volume (49 ± 16 to 57 ± 17 ml; P < 0.001) and indexed LV end-diastolic volume (LVEDV index : 57 ± 16 to 64 ± 16 ml m −2 ; P < 0.001) increased following PTMC while E es and E a returned to more normal levels. Elevated LV stiffness was demonstrated at baseline and increased further following PTMC. Our findings provide evidence of elevated LV contractility, increased arterial load and increased diastolic stiffness in severe MS. Following PTMC, both LV contractility and afterload tend to normalize.A. Manouras and A. I. Nagy contributed equally to this study.

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Acute changes in left ventricular function after percutaneous transluminal mitral valvuloplasty

et al. 1996

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Percutaneous balloon mitral valvuloplasty (PBMV) has been shown to induce an immediate increase in the left ventricular end-diastolic volume, which increase, in turn, has been attributed to an increase in left ventricular compliance. We studied 51 patients, 41 women and 10 men, who underwent PBMV, and were in sinus rhythm before and after the procedure. Heart rate did not vary significantly. There were increases in left ventricular end-diastolic volume (97.5 +/- 25.6 vs 112.7 +/- 25.7 ml/m2, P < 0.001), left ventricular end-diastolic pressure (8.7 +/- 3.0 vs 9.7 +/- 4.3 mmHg, P = 0.04), and both left ventricular systolic pressure and stress (118 +/- 20.5 vs 123 +/- 23.2 mmHg and 468 +/- 129 vs 580 +/- 164 mmHg; P = 0.04 and P < 0.001, respectively). The elastic stiffness constant did not vary (16.2 +/- 1.9 vs 15.7 +/- 1.9 (dimensionless units), P = 0.2). The increase in volume seemed to be particularly important when the ventricle appeared to be "shrunken" before PBMV. This increase was still present after a 1 year follow up. Thus, PBMV determines an increase in both end-diastolic volume and pressure, so that the left ventricle appears to move along a single pressure-volume curve. This enlargement evokes the Frank Starling mechanism, and improves systolic performance. Since it is still evident after a 1 year follow up, some concern may arise when a simultaneous volume overload is present, as in aortic insufficiency.

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Depressed myocardial contractility in mitral stenosis. An analysis by force-length and stress-shortening relationships.

Cited by 8 publications

References 0 publications

Left ventricular diastolic function in mitral stenosis

Left ventricular diastolic function in mitral stenosis

The impact of arterial load on left ventricular performance: an invasive haemodynamic study in severe mitral stenosis

Acute changes in left ventricular function after percutaneous transluminal mitral valvuloplasty

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