Predictive Value of Global Longitudinal Strain in a Surgical Population of Organic Mitral Regurgitation

Mascle, Sophie; Schnell, Frédéric; Thébault, Christophe; Corbineau, Hervé; Laurent, Marcel; Hamonic, Stéphanie; Veillard, D.; Mabo, Philippe; Leguerrier, Alain; Donal, Erwan

doi:10.1016/j.echo.2012.04.009

Cited by 81 publications

(64 citation statements)

References 33 publications

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“…This model replicates the hemodynamics and pathophysiology of VO HF progression, irrespective of the etiology, and is the only rodent model that can be used to model the hemodynamics of VO reversal (17)(18)(19)34). We previously demonstrated that reversal during pre-HF (i.e., 4 wk post-ACF) results in rapid structural recovery with delayed functional recovery, which mirrors human data where structure, but not function, returns postsurgically in 17% of patients with MR (27). The results from the single-myocyte experiments demonstrate that impaired LV function in REV is not explained by impaired sarcomere shortening or Ca 2ϩ handling.…”

Section: Discussionmentioning

confidence: 66%

“…In that report, REV during pre-HF (i.e., 4 wk post-ACF) results in rapid structural recovery but delayed functional recovery (19). Although this mirrors human data where structure, but not function, returns postsurgically in 17% of patients with MR (27), the mechanism underlying the delayed functional recovery remains elusive. Although the cellular mechanisms that control excitation-contraction coupling have been studied at end-stage HF (17), less is known about cellular dysfunction at earlier stages of HF.…”

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confidence: 91%

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Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure

Wilson

Guggilam

West

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

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Wilson K, Guggilam A, West TA, Zhang X, Trask AJ, Cismowski MJ, de Tombe P, Sadayappan S, Lucchesi PA. Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure. Am J Physiol Heart Circ Physiol 307: H1605-H1617, 2014. First published September 26, 2014 doi:10.1152/ajpheart.00423.2014.-Aortocaval fistula (ACF)-induced volume overload (VO) heart failure (HF) results in progressive left ventricular (LV) dysfunction. Hemodynamic load reversal during pre-HF (4 wk post-ACF; REV) results in rapid structural but delayed functional recovery. This study investigated myocyte and myofilament function in ACF and REV and tested the hypothesis that a myofilament Ca 2ϩ sensitizer would improve VOinduced myofilament dysfunction in ACF and REV. Following the initial sham or ACF surgery in male Sprague-Dawley rats (200 -240 g) at week 0, REV surgery and experiments were performed at weeks 4 and 8, respectively. In ACF, decreased LV function is accompanied by impaired sarcomeric shortening and force generation and decreased Ca 2ϩ sensitivity, whereas, in REV, impaired LV function is accompanied by decreased Ca 2ϩ sensitivity. Intravenous levosimendan (Levo) elicited the best inotropic and lusitropic responses and was selected for chronic oral studies. Subsets of ACF and REV rats were given vehicle (water) or Levo (1 mg/kg) in drinking water from weeks 4 -8. Levo improved systolic (% fractional shortening, end-systolic elastance, and preload-recruitable stroke work) and diastolic (, dP/ dt min) function in ACF and REV. Levo improved Ca 2ϩ sensitivity without altering the amplitude and kinetics of the intracellular Ca 2ϩ transient. In ACF-Levo, increased cMyBP-C Ser-273 and Ser-302 and cardiac troponin I Ser-23/24 phosphorylation correlated with improved diastolic relaxation, whereas, in REV-Levo, increased cMyBP-C Ser-273 phosphorylation and increased ␣-to-␤-myosin heavy chain correlated with improved diastolic relaxation. We concluded that Levo improves LV function, and myofilament composition and regulatory protein phosphorylation likely play a key role in improving function. myofilament dysfunction; myofilament Ca 2ϩ sensitization; levosimendan; myosin-binding protein-C; troponin I MITRAL REGURGITATION (MR) is the most and second most common valve lesion in the United States and Europe, respectively, affecting Ͼ2 million Americans (10, 16). The pathophysiological consequences of MR include chronic left ventricular (LV) hemodynamic volume overload (VO) followed by LV chamber dilation, progressive LV contractile dysfunction, and heart failure (HF). Despite the clinical importance of VO, few models mimic the pathophysiological progression of chronic VO with and without hemodynamic load reduction. The aortocaval fistula (ACF) model of VO HF in the rodent mimics increased hemodynamic preload observed in human disease, irrespective of etiology. In this model, chronically increased LV preload leads to progressive LV pump failure, which is classified into t...

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Section: Discussionmentioning

confidence: 66%

mentioning

confidence: 91%

Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure

Wilson

Guggilam

West

et al. 2014

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

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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.…”

mentioning

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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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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“…Furthermore, the measurement of LV global longitudinal strain is geometry and load dependent. 11,21 In opposition, LV ejection index is rapid to calculate and only requires measurement and images mandatory in routine echocardiographic examination.…”

Section: Ejection Index Versus LV Longitudinal Function Parametersmentioning

confidence: 99%

Clinical and Prognostic Impact of a New Left Ventricular Ejection Index in Primary Mitral Regurgitation Because of Mitral Valve Prolapse

Magné

Szymanski

Fournier

et al. 2015

Circ: Cardiovascular Imaging

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Background— To prevent left ventricular dysfunction (LVD), surgery is recommended in patients with severe primary mitral regurgitation as soon as ejection fraction (EF) ≤60% or LV end-systolic diameter ≥40 mm. However, LVD may be concealed behind preoperative normal LVEF and LV end-systolic diameter. We sought to identify whether a new composite echocardiographic Doppler marker of the LV ejection according to the LV dilatation may predict postoperative LVD and outcome after mitral valve repair in patients with primary mitral regurgitation. Methods and Results— Between 1991 and 2010, patients who underwent mitral valve repair for primary mitral regurgitation were studied. From preoperative echocardiography, we calculated LV ejection index (LVEI) using following formula: LVEI=indexed LV end-systolic diameter/LV outflow tract time–velocity integral. In the 278 patients included, the best correlation with postoperative LVEF was found with LVEI ( r =−0.40; P <0.0001), even in patients with preoperative LVEF≥60% ( r =−0.46; P <0.0001). In multivariable analysis, LCEI>1.13 was an independent predictor of postoperative LVD ( P <0.0001). During a mean follow-up of 10±4.6 years, 67 (29%) deaths occurred. When compared with patients with preserved LVEI, those with LVEI>1.13 had significantly lower both survival and cardiac death–free survival ( P =0.017 and P =0.008, respectively). Similar results were found in patients with preoperative LVEF≥60% ( P =0.049 and P =0.016, respectively). In Cox proportional hazard model, after meticulous adjustment for cofactors, LVEI>1.13 remains independently associated with death (hazard ratio, 1.64; P =0.039) and cardiac-related death (hazard ratio, 3.27; P =0.026). Conclusions— After mitral valve repair for primary mitral regurgitation, the preoperative LVEI is a new and simple composite parameter of both LV dilatation and LV forward flow able to accurately predict postoperative LVD and outcome.

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Predictive Value of Global Longitudinal Strain in a Surgical Population of Organic Mitral Regurgitation

Cited by 81 publications

References 33 publications

Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure

Effects of a myofilament calcium sensitizer on left ventricular systolic and diastolic function in rats with volume overload heart failure

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

Clinical and Prognostic Impact of a New Left Ventricular Ejection Index in Primary Mitral Regurgitation Because of Mitral Valve Prolapse

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