Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation

Izumo, Masaki; Lancellotti, Patrizio; Suzuki, Kazuhiro; Kou, Seisyou; Sugiyama, Takashi; Hayashi, Akio; Akashi, Yoshihiro; Osada, Naohiko; Omiya, Kazuto; Nobuoka, Sachihiko; Ohtaki, Eiji; Miyake, Fumihiko

doi:10.1093/ejechocard/jep114

Cited by 36 publications

(24 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Dynamic dyssynchrony has been demonstrated in hypertensive heart failure patients with normal ejection [22] and heart failure patients with impaired LV systolic function secondary to coronary heart disease and dilated cardiomyopathy [9], [21], [23] Importantly, dynamic ventricular dyssynchrony has been associated with impairment of increase in LV stroke volume during exercise [2], [23]. Our finding of significant negative correlations between ΔSDI and changes in LV ejection fraction and stroke volume during exercise corroborate the previous findings.…”

Section: Discussionsupporting

confidence: 89%

“…In dilated cardiomyopathy, development of ventricular dyssynchrony has been attributed to progressive myocardial fibrosis [4], [5]. Histological examination of myocardial biopsies from thalassaemia patients has revealed variable degree of fibrosis [6], while up-regulated expression of genes involved in fibrosis has been demonstrated in iron-overloaded cardiomyocytes [7], Evaluation of resting uncoordinated contraction of different LV segments and its exaggeration during exercise stress with possible haemodynamic consequences has been facilitated by the introduction of three-dimensional (3D) echocardiography [8], [9]. Data in thalassaemia patients in this regard are nonetheless lacking.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Dynamic Dyssynchrony and Impaired Contractile Reserve of the Left Ventricle in Beta-Thalassaemia Major: An Exercise Echocardiographic Study

Cheung

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

BackgroundPerformance of the left ventricle during exercise stress in thalassaemia patients is uncertain. We aimed to explore the phenomenon of dynamic dyssynchrony and assess contractile reserve in patients with beta-thalassaemia major and determine their relationships with myocardial iron load.Methods and ResultsThirty-two thalassaemia patients (16 males), aged 26.8±6.9 years, without heart failure and 17 healthy controls were studied. Their left ventricular (LV) volumes, ejection fraction, systolic dyssynchrony index (SDI), and myocardial acceleration during isovolumic LV contraction (IVA) were determined at rest and during submaximal bicycle exercise testing using 3-dimensional and tissue Doppler echocardiography. Myocardial iron load as assessed by T2* cardiac magnetic resonance in patients were further related to indices of LV dyssynchrony and contractile reserve. At rest, patients had significantly greater LV SDI (p<0.001) but similar IVA (p = 0.22) compared with controls. With exercise stress, the prevalence of mechanical dyssynchrony (SDI>4.6%, control+2SD) increased from baseline 25% to 84% in patients. Δ SDIexercise-baseline correlated with exercise-baseline differences in LV ejection fraction (p<0.001) and stroke volume (p = 0.006). Compared with controls, patients had significantly less exercise-induced increase in LV ejection fraction, cardiac index, and IVA (interaction, all p<0.05) and had impaired contractile reserve as reflected by the gentler IVA-heart rate slope (p = 0.018). Cardiac T2* in patients correlated with baseline LV SDI (r = −0.44, p = 0.011) and IVA-heart rate slope (r = 0.36, p = 0.044).ConclusionsResting LV dyssynchrony is associated with myocardial iron load. Exercise stress further unveils LV dynamic dyssynchrony and impaired contractile reserve in patients with beta-thalassaemia major.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Dynamic Dyssynchrony and Impaired Contractile Reserve of the Left Ventricle in Beta-Thalassaemia Major: An Exercise Echocardiographic Study

Cheung

et al. 2012

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The primary determinants of exercise-related deterioration in MR appear to be systolic annular area, degree of tenting of the valve and the associated wall motion abnormalities (42). These are dependent on the extent of ischaemic damage, exercise-induced dyssynchrony and the presence or absence of viability within the myocardium and papillary muscles; indeed, the severity of MR may reduce in patients with viable myocardium due to myocardial recruitment (43, 44, 45). Whether secondary MR improves or deteriorates on exercise is important as an increase in severity of MR with exercise by EROA ≥13 mm 2 is associated with a five-fold increased risk of subsequent cardiac death (46).…”

Section: Secondary Mrmentioning

confidence: 99%

“…First, there are those whose symptoms of breathlessness appear to be disproportionate to the extent of LV impairment or the severity of MR. Exercise echocardiography can be used both to confirm objectively the extent of physical limitation (54), together with an imaging strategy that can define the extent of resting LV impairment, presence of ischaemia, development of dyssynchrony and alteration in the degree of MR during stress (5, 40, 42, 43). Secondly, the degree of secondary MR that is considered significant is relatively minor (EROA ≤13 mm 2 ).…”

Section: Stress Echocardiography In Secondary Mr?mentioning

confidence: 99%

Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography

Liu

Edwards

Ray³

et al. 2016

Echo Res Pract

View full text Add to dashboard Cite

Mitral regurgitation (MR) is the second most common form of valvular disease requiring surgery. Correct identification of surgical candidates and optimising the timing of surgery are key in management. For primary MR, this relies upon a balance between the peri-operative risks and rates of successful repair in patients undergoing early surgery when asymptomatic with the potential risk of irreversible left ventricular dysfunction if intervention is performed too late. For secondary MR, recognition that this is a highly dynamic condition where MR severity may change is key, although data on outcomes in determining whether concomitant valve intervention is performed with revascularisation has raised questions regarding timing of surgery. There has been substantial interest in the use of stress echocardiography to risk stratify patients in mitral regurgitation. This article reviews the role of stress echocardiography in both primary and secondary mitral regurgitation and discusses how this can help clinicians tackle the challenges of this prevalent condition.

show abstract

“…Lastly, the effects of exercise and dynamic changes caused in patients with heart failure and mitral regurgitation have been recently evaluated. A 3DE analysis demonstrated exercise-induced changes in cardiac synchrony, sphericity, and coaptation distance that may change the severity of MR in some patients [14].…”

Section: Functional Mitral Regurgitationmentioning

confidence: 99%

Three-Dimensional Echocardiography and Mitral Valve Disease

Chapman

Rahko

2010

Curr Cardiol Rep

View full text Add to dashboard Cite

Three-dimensional echocardiography is a growing imaging modality, particularly for the evaluation of mitral valve pathology. Functional anatomy in disease states such as mitral regurgitation and stenosis as well as prosthetic valves can be effectively studied, offering superior knowledge to treating physicians. Additionally, three-dimensional echocardiography has the ability to help guide operative and percutaneous interventions, allowing for improved patient outcomes and advancement of clinical research. Continued experience with three-dimensional echocardiography will further our knowledge of the mitral valve and refine current indications for cardiovascular imaging.

show abstract

Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation

Abstract: Dynamic MR during exercise is related to the 3D changes in LV shape and in LV synchronicity.

Cited by 36 publications

References 23 publications

Dynamic Dyssynchrony and Impaired Contractile Reserve of the Left Ventricle in Beta-Thalassaemia Major: An Exercise Echocardiographic Study

Dynamic Dyssynchrony and Impaired Contractile Reserve of the Left Ventricle in Beta-Thalassaemia Major: An Exercise Echocardiographic Study

Timing surgery in mitral regurgitation: defining risk and optimising intervention using stress echocardiography

Three-Dimensional Echocardiography and Mitral Valve Disease

Contact Info

Product

Resources

About