The relation between mitral annulus motion and ejection fraction: A nonlinear function

Emilsson, Kent; Alam, Mahbubul; Wandt, Birger

doi:10.1067/mje.2000.107253

Cited by 44 publications

(40 citation statements)

References 19 publications

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“…MA area change from MA area at ED ranged from a minimum value of Ϫ4.4Ϯ6.1% to a maximum value of 25.4Ϯ12.7%. As expected, the MA motion curve resembled the LV volume curve 2,12 and reached its maximum distance from MA ED position at ES (7.7Ϯ2.8 mm). MA anterior section showed less motion throughout the cardiac cycle than the posterior MA section, with maximum anterior MA displacement (7.4Ϯ2.5 mm) being significantly smaller than the posterior value (8.2Ϯ3.2 mm).…”

Section: Resultsmentioning

confidence: 61%

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Veronesi

Corsi

Sugeng

et al. 2009

Circ: Cardiovascular Imaging

114

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Background— Mitral and aortic valves are known to be coupled via fibrous tissue connecting the two annuli. Previous studies evaluating this coupling have been limited to experimental animals using invasive techniques. The new matrix array transesophageal transducer provides high-resolution real-time 3D images of both valves simultaneously. We sought to develop and test a technique for quantitative assessment of mitral and aortic valve dynamics and coupling. Methods and Results— Matrix array transesophageal (Philips iE33) imaging was performed in 24 patients with normal valves who underwent clinically indicated transesophageal echocardiography. Custom software was used to detect and track the mitral and aortic annuli in 3D space throughout the cardiac cycle, allowing automated measurement of changes in mitral and aortic valve morphology. Mitral annulus surface area and aortic annulus projected area changed reciprocally over time. Mitral annulus surface area was 8.0�2.1 cm 2 at end-diastole and decreased to 7.7�2.1 cm 2 in systole, reaching its maximum (10.0�2.2 cm 2 ) at mitral valve opening. Aortic annulus projected area was 4.1�1.2 cm 2 at end-diastole, then increased during isovolumic contraction reaching its maximum (4.8�1.3 cm 2 ) in the first third of systole and its minimum (3.6�1.0 cm 2 ) during isovolumic relaxation. The angle between the mitral and aortic annuli was maximum (136�13�) at end-diastole and decreased to its minimum value (129�11�) during systole. Conclusions— This is the first study to report quantitative 3D assessment of the mitral and aortic valve dynamics from matrix array transesophageal images and describe the mitral-aortic coupling in a beating human heart. This ability may have impact on patient evaluation for valvular surgical interventions and prosthesis design.

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Section: Resultsmentioning

confidence: 61%

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Veronesi

Corsi

Sugeng

et al. 2009

Circ: Cardiovascular Imaging

114

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“…24 25 This correlation is logarithmic rather than linear. 26 Unlike M mode echocardiography, TDi can be used to calculate both the amplitude and the velocity of mitral annular motion and reliably reflects changes in cardiac contractility, ejection fraction, ejection time and pressures, and ''latent'' left ventricular dysfunction. [27][28][29][30][31][32][33][34] TDi has good reproducibility 35 and may identify left ventricular dysfunction before conventional indices are abnormal.…”

Section: -8mentioning

confidence: 99%

Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure

Witte

2004

Heart

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Objective: To examine the relation between longitudinal left ventricular function assessed by tissue Doppler imaging (TDi) and exercise capacity in heart failure. Subjects: 153 patients with chronic heart failure from left ventricular systolic dysfunction (ejection fraction , 45%) and 87 age and sex matched controls. Methods: Echocardiography was used to measure conventional indices of left ventricular systolic function. TDi was used to assess left and right ventricular longitudinal function by measuring mitral and lateral tricuspid annular velocities during the cardiac cycle. Velocities measured at each point were the systolic peak (S m ) and the diastolic troughs (E m and A m ), corresponding to passive and active (atrial) left ventricular filling. Each patient also underwent treadmill exercise testing with metabolic gas exchange measurements. P atients with chronic heart failure complain of exercise intolerance, usually because of breathlessness and fatigue.1 Incremental exercise testing with metabolic gas exchange measurements used to derive peak oxygen consumption (pVO 2 ) allows an objective assessment of symptoms and exercise capacity. Generally, resting echocardiographic variables predict exercise capacity poorly in chronic heart failure. Resting left ventricular ejection fraction (LVEF) correlates weakly with exercise capacity 3-8 and other markers of exercise capacity, such as the slope of the relation between ventilation (VE) and carbon dioxide production (VCO 2 ) (VE/VCO 2 slope). Many patients with reduced exercise capacity have similar global left ventricular function to less limited individuals. Tissue Doppler imaging (TDi) allows quantitative assessment of the motion of the myocardium and is particularly helpful in quantifying ventricular long axis function.15 TDi can be used to assess both regional and global left ventricular function. Measuring myocardial velocities gives information about regional ventricular contractility, while, as a consequence of the relative immobility of the cardiac apex, the measurement of mitral annular velocities provides information on longitudinal left ventricular function. Regardless of the site of the measurement, the normal TDi profile has a characteristic appearance, consisting of systolic and diastolic myocardial motion (fig 1). Systolic motion often has two peaks, S9 and S m . S9 reflects isovolumic contraction, while S m occurs during ejection. Diastolic velocities, seen as troughs, consist of early and late myocardial movement (E m and A m ). These correspond to passive ventricular filling and atrial contraction, as do the E and A waves of transmitral flow. Mitral annular velocities are less preload dependent than conventional Doppler indices of mitral inflow 16 although the diastolic waveforms are not entirely preload independent. 17Tricuspid annular profiles are similar to those from the mitral annulus. Right ventricular S m velocity correlates with right ventricular ejection fraction (RVEF) measured by first pass radionuclide ventriculography in chronic h...

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“…Scaling of D and SV with growth or heart size is therefore important to assess (23,24). Because both SV and ET scales differently to body size, the different impact of ET and SV on SЈ may change during developmental growth (14,25,26). ET is determined mainly by HR and inotropic state (27)(28)(29).…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Myocardial Contribution to Peak Systolic Flow and Stroke Volume in the Neonatal Heart

et al. 2011

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Systolic longitudinal myocardial function is important for cardiac ejection. Data describing hemodynamic determinants and the time course of myocardial longitudinal contraction as measured by tissue Doppler are lacking. Ten newborn pigs were used for invasive hemodynamic investigation. Tissue Doppler assessment of the lateral part of the mitral valve annulus during systole was performed during pharmacological modulation of inotropy, cardiac pacing, and modulations of loading conditions. The strongest association was found between peak systolic velocity (SЈ) and peak systolic flow (PSF) and end-systolic pressure (ESP), respectively (␤ ϭ 0.09 cm/mL, p Ͻ 0.001 and ␤ ϭ Ϫ0.07 cm/mL, p ϭ 0.003). Displacement (D) was mostly influenced by stroke volume (SV) (␤ ϭ 0.05 cm/mL, p Ͻ 0.001). Ejection time, SV, ESP, maximum first derivative of pressure (dP/dt max ), and PSF were all associated with SЈ and D under different states of hemodynamic modulation; however, the ratio between PSF and SЈ, SV, and D were stable during hemodynamic modulations. Normalized cross correlations indicate that SЈ and D follow the same trajectory as flow and SV, respectively. In conclusion, this study provides validity of accounting systolic D in the long axis as the longitudinal contribution to SV and peak systolic tissue velocity as the longitudinal contribution to PSF. S ystolic excursion and motion of the mitral valve annulus has been evaluated for myocardial function in both children and adults (1,2). It is easily obtainable in most patients and has the potential of being a routine parameter for assessment of myocardial function (3). Most available data are generated on the basis of studies in adults or experimental data from mature animal studies. In children, data are being published, but validated data explaining changes that occur within and between individuals at all age groups are lacking (4).This study was designed to possibly understand the nature of longitudinal peak systolic velocity (SЈ) and systolic displacement (D) when acting under the influence of hemodynamic changes in small individuals. Neonatal pigs were chosen because of the similarity to human neonates with regards to heart size and heart rate (HR). METHODSPopulation. Ten pigs (age 3-6 d, weight 2520 -6080 g) were studied under general anesthesia. A total of 185 echocardiographic assessments were performed. Twenty (11%) assessments were excluded mainly due to no capture during right atrial pacing, missing data file, or atrial contraction before mitral valve opening during pacing. All animals were in good health without overt clinical signs of disease. The experimental protocol was approved by the Norwegian Animal Research Authority. The animals were cared for and handled in accordance with the European Guidelines for Use of Experimental Animals.Experimental model. The piglets were anesthetized with sevoflurane for i.v. cannulation and maintained on midazolam, fentanyl, and penthobarbital. The animals were mechanically normoventilated (fraction of inhaled oxygen [...

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The relation between mitral annulus motion and ejection fraction: A nonlinear function

Cited by 44 publications

References 19 publications

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

A Study of Functional Anatomy of Aortic-Mitral Valve Coupling Using 3D Matrix Transesophageal Echocardiography

Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure

Longitudinal Myocardial Contribution to Peak Systolic Flow and Stroke Volume in the Neonatal Heart

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