Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation

Florescu, Maria; Benea, Diana; Rimbaş, Roxana Cristina; Cerin, F.E.S.C. Gheorghe; Diena, Marco; Lanzzillo, Guido; Enescu, Oana Aurelia; Cintezǎ, Mircea; Vinereanu, F.E.S.C. Dragos

doi:10.1111/j.1540-8175.2011.01563.x

Cited by 35 publications

(24 citation statements)

References 37 publications

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“…Impaired LV-GLS in asymptomatic patients with severe MR and preserved ejection fraction have been shown in several previous reports to predict postoperative LV dysfunction after MV surgery. [18][19][20][21][22][23] However, these reports had relatively small sample sizes and short follow-up durations. In addition, no survival analysis was reported.…”

Section: Discussionmentioning

confidence: 99%

“…17 In patients with significant MR, abnormal baseline LV-GLS is associated with a reduction in postoperative LVEF. [18][19][20][21][22][23] However, prognostic data regarding the role of LV-GLS in MR patients is sparse. 24,25 Furthermore, to the best of our knowledge, the potential additive value of BNP and LV-GLS in risk stratification of patients with significant MR who underwent MV surgery has not been previously studied.…”

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confidence: 99%

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Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Alashi

Mentias

Patel

et al. 2016

Circ: Cardiovascular Imaging

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I n the developed world, myxomatous degeneration of the mitral valve (MV) is the most common cause of mitral regurgitation (MR).1,2 Surgical correction remains the cornerstone of management in severe primary MR because medical management alone does not improve the hemodynamic consequences of the regurgitant valve and its impact on outcome. 3,4 According to the most recent guidelines, indications for surgical intervention in patients with severe primary MR are development of symptoms, asymptomatic left ventricular (LV) systolic dysfunction, new-onset AF, or pulmonary arterial hypertension.5 However, appropriate timing of surgical intervention in asymptomatic severe primary MR is often challenging. Advances in MV repair have led to excellent long-term results with low morbidity and mortality at experienced centers 6,7 such that the threshold to recommend surgical intervention at these centers has been lowered by the guidelines when Background-In asymptomatic patients with ≥3+ mitral regurgitation and preserved left ventricular (LV) ejection fraction who underwent mitral valve surgery, we sought to discover whether baseline LV global longitudinal strain (LV-GLS) and brain natriuretic peptide provided incremental prognostic utility. Methods and Results-Four hundred and forty-eight asymptomatic patients (61±12 years and 69% men) with ≥3+ primary mitral regurgitation and preserved left ventricular ejection fraction, who underwent mitral valve surgery (92% repair) at our center between 2005 and 2008, were studied. Baseline clinical and echocardiographic data (including LV-GLS using Velocity Vector Imaging, Siemens, PA) were recorded. The Society of Thoracic Surgeons score was calculated. The primary outcome was death. Mean Society of Thoracic Surgeons score, left ventricular ejection fraction, mitral effective regurgitant orifice, indexed LV end-diastolic volume, and right ventricular systolic pressure were 4±1%, 62±3%, 0.55±0.2 cm 2 , 58±13 cc/m 2 , and 37±15 mm Hg, respectively. Forty-five percent of patients had flail. Median log-transformed BNP and LV-GLS were 4.04 (absolute brain natriuretic peptide: 60 pg/dL) and −20.7%. At 7.7±2 years, death occurred in 41 patients (9%; 0% at 30 days). On Cox analysis, a higher Society of Thoracic Surgeons score (hazard ratio 1.55), higher baseline right ventricular systolic pressure (hazard ratio 1.11), more abnormal LV-GLS (hazard ratio 1.17), and higher median log-transformed BNP (hazard ratio 2.26) were associated with worse longer-term survival (all P<0.01). Addition of LV-GLS and median log-transformed BNP to a clinical model (Society of Thoracic Surgeons score and baseline right ventricular systolic pressure) provided incremental prognostic utility (χ 2 for longer-term mortality increased from 31-47 to 61; P<0.001). Conclusions-In asymptomatic patients with significant primary mitral regurgitation and preserved left ventricular ejection fraction who underwent mitral valve surgery, brain natriuretic peptide and LV-GLS provided synergistic risk stratification, independent o...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Alashi

Mentias

Patel

et al. 2016

Circ: Cardiovascular Imaging

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“…However, despite normal LVEF, asymptomatic patients with mitral regurgitation often demonstrate reduced longitudinal and radial strain. 77 Longitudinal SR may be more attenuated than circumferential or radial SR. 78 Furthermore, LV untwisting is delayed in patients with mitral regurgitation and may provide early signs of LV dysfunction. 79 …”

Section: Early Detection Of Myocardial Diseasementioning

confidence: 99%

“…75 Likewise, reduced preoperative longitudinal strain predicted a 10% or greater reduction in postoperative LVEF. 77 Abnormal longitudinal and radial SR identified patients at risk for irreversible myocardial damage. 81 Moreover, a recent study found that impaired longitudinal strain worse than −19.9% predicted long-term LV dysfunction after mitral valve repair.…”

Section: Early Detection Of Myocardial Diseasementioning

confidence: 99%

Perioperative Assessment of Myocardial Deformation

Duncan

Alfirevic

Sessler

et al. 2014

Anesthesia &Amp; Analgesia

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Evaluation of left ventricular performance improves risk assessment and guides anesthetic decisions. However, the most common echocardiographic measure of myocardial function, the left ventricular ejection fraction (LVEF), has important limitations. LVEF is limited by subjective interpretation which reduces accuracy and reproducibility, and LVEF assesses global function without characterizing regional myocardial abnormalities. An alternative objective echocardiographic measure of myocardial function is thus needed. Myocardial deformation analysis, which performs quantitative assessment of global and regional myocardial function, may be useful for perioperative care of surgical patients. Myocardial deformation analysis evaluates left ventricular mechanics by quantifying strain and strain rate. Strain describes percent change in myocardial length in the longitudinal (from base to apex) and circumferential (encircling the short-axis of the ventricle) direction and change in thickness in the radial direction. Segmental strain describes regional myocardial function. Strain is a negative number when the ventricle shortens longitudinally or circumferentially and is positive with radial thickening. Reference values for normal longitudinal strain from a recent meta-analysis using transthoracic echocardiography are (mean ± SD) −19.7 ± 0.4%, while radial and circumferential strain are 47.3 ± 1.9 and −23.3 ± 0.7%, respectively. The speed of myocardial deformation is also important and is characterized by strain rate. Longitudinal systolic strain rate in healthy subjects averages −1.10 ± 0.16 sec−1. Assessment of myocardial deformation requires consideration of both strain (change in deformation), which correlates with LVEF, and strain rate (speed of deformation), which correlates with rate of rise of left ventricular pressure (dP/dt). Myocardial deformation analysis also evaluates ventricular relaxation, twist, and untwist, providing new and noninvasive methods to assess components of myocardial systolic and diastolic function. Myocardial deformation analysis is based on either Doppler or a non-Doppler technique, called speckle-tracking echocardiography. Myocardial deformation analysis provides quantitative measures of global and regional myocardial function for use in the perioperative care of the surgical patient. For example, coronary graft occlusion after coronary artery bypass grafting is detected by an acute reduction in strain in the affected coronary artery territory. In addition, assessment of left ventricular mechanics detects underlying myocardial pathology before abnormalities become apparent on conventional echocardiography. Certainly, patients with aortic regurgitation demonstrate reduced longitudinal strain before reduction in LVEF occurs, which allows detection of subclinical left ventricular dysfunction and predicts increased risk for heart failure and impaired myocardial function after surgical repair. In this review we describe the principles, techniques, and clinical application of myocardial deformation...

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“…1 Reduced strain was associated with a drop in LV EF after mitral valve repair. 1 Reduced strain was associated with a drop in LV EF after mitral valve repair.…”

Section: See Article On Page 326mentioning

confidence: 99%

On Early Detection of Myocardial Dysfunction in Asymptomatic Severe Mitral Regurgitation

Pai

2012

Echocardiography

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Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation

Abstract: Myocardial systolic velocities as well as radial and longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR.

Cited by 35 publications

References 37 publications

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Synergistic Utility of Brain Natriuretic Peptide and Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Primary Mitral Regurgitation and Preserved Systolic Function Undergoing Mitral Valve Surgery

Perioperative Assessment of Myocardial Deformation

On Early Detection of Myocardial Dysfunction in Asymptomatic Severe Mitral Regurgitation

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