Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes

Neilan, Tomas G.; Ton-Nu, Thanh-Thao; Kawase, Yoshiaki; Yoneyama, Ryuichi; Hoshino, Kozo; Monte, Federica del; Hajjar, Roger J.; Picard, Michael H.; Levine, Robert A.; Hung, Judy

doi:10.1152/ajpheart.01128.2007

Cited by 16 publications

(12 citation statements)

References 38 publications

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“…Under these experimental conditions these indices do not allow detection of changes in LV function during the very early stage of the disease, and this is consistent with recent findings 23. Accordingly, a correlation analysis between changes in strain and changes in PRSW, EF or Tau, did not show any closer association between the parameters.…”

Section: Discussionsupporting

confidence: 85%

“…Moreover, Marciniak et al22 proposed that, if corrected for LV geometry, tissue Doppler based strain rate could be a sensitive tool to detect subclinical LV dysfunction in asymptomatic patients with severe MR. In a porcine chronic MR model, Neilan et al23 recently showed that tissue Doppler-derived strain and strain rate indices, which initially increased post-MR, decreased to baseline before any detected changes in global LVEF.…”

Section: Discussionmentioning

confidence: 99%

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Alterations in Transmural Myocardial Strain

Carlhäll

Nguyen

Itoh³

et al. 2008

Circulation

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Background-In asymptomatic patients with severe isolated mitral regurgitation (MR), identifying the onset of early left ventricular (LV) dysfunction can guide the timing of surgical intervention. We hypothesized that changes in LV transmural myocardial strain represent an early marker of LV dysfunction in an ovine chronic MR model. Methods and Results-Sheep were randomized to control (CTRL, nϭ8) or experimental (EXP, nϭ12) groups. In EXP, a 3.5-or 4.8-mm hole was created in the posterior mitral leaflet to generate "pure" MR. Transmural beadsets were inserted into the lateral and anterior LV wall to radiographically measure 3-dimensional transmural strains during systole and diastolic filling, at 1 and 12 weeks postoperatively. MR grade was higher in EXP than CTRL at 1 and 12 weeks

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Alterations in Transmural Myocardial Strain

Carlhäll

Nguyen

Itoh³

et al. 2008

Circulation

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“…Although a high LVEF and LVFS was observed in the early stage of MR (within the first 6 -12 wk), decrease in LVEF and LVFS was seen in the late stage. Using a pig model of chronic organic MR, Neilan and colleagues (17) showed that the LV was progressively dilated at 1 and 3 mo induction of MR, but LVEF did not decrease. LV remodeling is associated with systolic impairment.…”

Section: Discussionmentioning

confidence: 99%

Impact of mitral regurgitation on left ventricular anatomic and molecular remodeling and systolic function: implication for outcome

Pu¹,

Gao

Zhang³

et al. 2009

American Journal of Physiology-Heart and Circulatory Physiology

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The aim of the study was to assess the impact of mitral regurgitation (MR) on left ventricular (LV) anatomic and molecular remodeling and function and to determine whether early LV remodeling and function predict long-term outcome in experimental organic MR. A new rodent model of chronic MR was created. Twenty-eight rats had surgically induced MR, twelve rats had a sham operation, and twelve rats had no operation. LV diameters, volume, and mass and LV ejection fraction (LVEF) and LV fractional shortening (LVFS) were assessed using echocardiography in the early stage of MR (6 and 12 wk after induction of MR). LV hemodynamics was assessed invasively. Cardiac alpha- and beta-myosin heavy chains and sarco(endo)plasmic reticulum Ca(2+)-ATPase 2 (SERCA2) were measured to assess molecular remodeling and contractility. Cox's proportional hazard ratios (HR) were used to identify outcome predictors. Early LV dilation was demonstrated in rats with MR when LVEF and LVFS were still normal. LV remodeling was associated with an increase in LV end-diastolic pressure and decrease in maximal change in pressure over time. Shifting of alpha- to beta-myosin and reduced SERCA2 were observed in rats with MR. Cox's proportional hazard analysis showed that LV end-diastolic diameters (HR, 1.2-2.4; P = 0.007) and LV end-diastolic volume (HR, 1.1-1.4; P = 0.005) at 6 wk and LV mass index (HR, 1.1-2.0; P = 0.004) at 12 wk after induction of MR were significantly associated with 1-yr mortality. However, LVEF (HR, 0.7-6.8 for the 6 wk, P > 0.05; and HR, 0.4-3.2 for the 12 wk, P > 0.05) and LVFS (HR, 0.4-1.4 for the 6 wk; and 0.4-3.1 for the 12 wk, P > 0.05) did not predict late death. Chronic MR leads to LV anatomic and cellular remodeling and impaired contractility. The time course of LV remodeling and function changes in the rat model of MR is similar to humans. Prediction of outcome may be achieved by assessments of early LV remodeling.

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“…Hence, a reduction in longitudinal s' appears to carry independent prognostic information beyond the impact of LVEF in hypertension [11], heart failure [12] and coronary artery disease [13]. The predictive utility of pulsed Doppler TDI is not restricted to ischaemia; for example, TDI not only falls before any change in LVEF in severe mitral regurgitation [14] but also predicts those patients in whom LVEF will fall following mitral valve replacement [15].…”

Section: Systolic Functionmentioning

confidence: 99%

Echocardiography: frontier imaging in cardiology

Steeds¹

2011

BJR

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ABSTRACT. This article reviews the recent developments in echocardiography that have maintained this technology at the forefront of day-to-day imaging in clinical cardiology. The primary reason for most requests for imaging in cardiovascular medicine is to assess left ventricular structure and function. As our understanding of left ventricular mechanics has become more intricate, tissue Doppler and speckle tracking modalities have been developed that deliver greater insights into diagnosis of cardiomyopathy and earlier warning of ventricular dysfunction. Increased accuracy has been achieved with the dissemination of real-time three-dimensional echocardiography, which has also acquired a central role in the pre-operative assessment of patients prior to reparative valvular surgery. The use of contrast has broadened the indications for transthoracic echocardiography and has increased the accuracy of stress echocardiography, while reducing the number of patients who cannot be scanned because of a limited acoustic window. Finally, echocardiography will be seen in the future not only as a diagnostic tool in those affected by cardiovascular disease but also as a method for prediction of risk and perhaps activation of targeted treatment. Echocardiography is one of the most commonly performed cardiac investigations. It is a group of interrelated applications of ultrasound applied specifically to the heart, and is most often the first imaging modality to be used on any patient presenting with suspected cardiovascular disease. The annual number of standard transthoracic echocardiograms (TTE) performed ranges from 9167 per million in Wales to 15 294 per million in Northern Ireland; this number has increased rapidly over the past decade and continued growth is expected [1]. The large majority of echocardiograms are performed by cardiac physiologists, and over 88% are reported by them [2].To a large extent, the progressive increase in use of echocardiography mirrors the decline in the clinical examination skills previously required for diagnosis in cardiology [3]. There are several reasons for this decline in clinical technique. First, it is generally recognised that the clinical diagnosis of many common cardiac conditions, such as pericardial effusion, early ventricular dysfunction, early cardiomyopathy and silent valve disease, is a challenge to the most experienced clinician, whereas these conditions are rapidly diagnosed by echocardiography [4]. Second, early aetiological diagnosis leads to the rapid institution of an appropriate management plan: the frequency of cardiovascular misdiagnosis in unselected patients who died in hospital has halved over the past 20 years and this decrease has paralleled the increasing use of echocardiography [5]. Third, unsuspected and not clinically apparent abnormalities are regularly detected by echocardiography and may have an important bearing on therapeutic decisions and outcome [6]. Miniaturisation has meant that studies can be carried out anywhere, with good quality images obtained fr...

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Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes

Abstract: Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes.

Cited by 16 publications

References 38 publications

Alterations in Transmural Myocardial Strain

Alterations in Transmural Myocardial Strain

Impact of mitral regurgitation on left ventricular anatomic and molecular remodeling and systolic function: implication for outcome

Echocardiography: frontier imaging in cardiology

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