P6130Left heart longitudinal deformation parameters in asymptomatic patients with mitral regurgitation

Abstract

echocardiography. It has been suggested that a pattern of reduced LV longitudinal strain with "apical sparing" may accurately identify cardiac AMI. Purpose: To analyze patients with both physiologic and pathologic primary and secondary LVH in order to select echocardiographic anatomic and functional variables that could accurately identify cardiac AMI. Methods: We examined 192 patients with LVH (hypertension, n=60; aortic stenosis, n=45, HCM, n=28; athlete's heart, n=40; non-compaction, n=4; amyloidosis, n=15; other restrictive, n=6), compared to 60 age matched normal subjects, using echographic GE Vivid 7 and systems. We measured: m-mode LV hypertrophy index (LV wall thickness/radius ratio) and mass index; biplane LV volumes and ejection fraction (EFb); Tei index (MPI, isovolumic intervals/ejection time ratio); mean systolic (s', cm/s) and early diastolic (e') tissue Doppler velocities of the mitral annulus (lateral and septal); LV filling pressures (Ep/e'); maximum and minimum left atrial (LA) volumes and the LA compliance index (LAres, ml)= (maximum -minimum volume); LV global peak systolic longitudinal strain (GLPSS, %), the mean longitudinal peak systolic strain of apical (ALPSS) and basal (BLPSS) segments, and their ratio (A/BLPSS); peak systolic (SRs, s -1 ) and early diastolic (SRd, s -1 ) global strain rate.Results: Compared to all other groups, only the hypertrophy index was significantly higher in AMI patients (0.88±0.117, da p<0.01 a p<0.001); the increase in mass index -prevalently in AMI and HCM -was not significant because of high variability. In contrast with LV volumes, systolic and diastolic LV function indices, and maximum LA volume, only LAres was significantly reduced in AMI patients compared to all other groups (15±8, p<0.001). Strain analysis showed the greatest reduction of GLPSS in AMI (-8±3%, p<0.001), secondary to marked reduction of BLPSS (-4±3%, p<0.001 vs all groups), whereas A/BLPSS, SRs and SRd were similar between study groups. Finally, decisional tree analysis identified 2 nodes using LAres (cutoff= 25 ml) and GLPSS (cutoff= -13%), correctly identifying AMI patients with 96.3% accuracy (93,3% sensitivity and 96.6% specificity). Conclusions: An algorithm combining LV longitudinal systolic strain and LA compliance provides accurate differential diagnosis of cardiac AMI. Apparent "apical sparing" is secondary to marked longitudinal dysfunction of the LV basal segments, and hence of global longitudinal function. Impairment of LA compliance may be secondary to both increased LV stiffness and amyloid deposits in the LA wall. Background: Changes in Global Longitudinal Strain (GLS) are often the first signs of functional impairment during cardiovascular disease development. As an explanation for this observation, the reflection of subendocardial function by GLS assessment is widely assumed, since the subendocardium has a unique vulnerability against cardiac injury and determines longitudinal mechanics of the left ventricle. However, there is a lack of studies correlating directly assess...