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Biondi-Zoccai G, Metsovitis T, Fresch B, Bernardi M, Perone F. Percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis: the earlier the merrier? HEART, VESSELS AND TRANSPLANTATION 2023; 0. [DOI: 10.24969/hvt.2023.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
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Pandian NG, Kim JK, Arias-Godinez JA, Marx GR, Michelena HI, Chander Mohan J, Ogunyankin KO, Ronderos RE, Sade LE, Sadeghpour A, Sengupta SP, Siegel RJ, Shu X, Soesanto AM, Sugeng L, Venkateshvaran A, Campos Vieira ML, Little SH. Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:3-28. [PMID: 36428195 DOI: 10.1016/j.echo.2022.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.
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Affiliation(s)
| | - Jin Kyung Kim
- University of California, Irvine, Irvine, California
| | | | | | | | | | | | | | | | - Anita Sadeghpour
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | - Amiliana M Soesanto
- Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
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Roslan A, Aris FA, Sin TY, Ashari A, Shaparudin AA, Shah WFWR, Jhung LT, Beng KH, Aktifanus ATJ, Nuruddin AA. Comprehensive echocardiographic and speckle tracking strain analysis in rheumatic mitral stenosis patients before and after transvenous mitral commissurotomy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1307-1316. [PMID: 34978670 DOI: 10.1007/s10554-021-02518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Percutaneous Transvenous Mitral Commissurotomy (PTMC) is the first line treatment for rheumatic mitral stenosis (MS). We sought to evaluate (1) changes in 2-dimensional (2D) echocardiographic and strain values and (2) differences in these values for patients in atrial fibrillation (AF) and sinus rhythm (SR) pre, immediately and 6 months post PTMC. Retrospective study of 136 patients who underwent PTMC between 2011 and 2021. We analyzed their 2D echocardiogram, Global Longitudinal Strain (GLS), Left Atrial Reservoir Strain (LAr-S) and Right Ventricle Free Wall Strain (RVFW-S) pre, immediately and 6 months post PTMC. At 6 months, mitral valve area increases from 0.94 ± 0.23 cm2 to 1.50 ± 0.42 cm2. Ejection fraction (EF) did not change post PTMC (pre; 55.56 ± 6.62%, immediate; 56.68 ± 7.83%, 6 months; 56.28 ± 7.00%, p = 0.218). Even though EF is preserved, GLS is lower pre-procedure; - 11.52 ± 3.74% with significant improvement at 6 months; - 15.16 ± 4.28% (p < 0.001). Tricuspid annular plane systolic excursion (TAPSE) improved at 6 months from 1.95 ± 0.43 to 2.11 ± 0.49 (p = 0.004). RVFW-S increases at 6 months from - 17.37 ± 6.03% to - 19.75 ± 7.19% (p = 0.011). LAr-S improved from 11.23 ± 6.83% pre PTMC to 16.80 ± 8.82% at 6 months (p < 0.001) post PTMC. Pre-procedure patients with AF have lower strain values (More LV, RV and LA dysfunction) with statistically significant difference for LAr-S (p < 0.001), GLS (p < 0.001) and RVFW-S (p < 0.001) than patients in SR. Patients with severe rheumatic MS have subclinical left and right ventricle dysfunction despite preserved EF and relatively normal TAPSE with significant improvement seen at 6 months post PTMC. AF patients have lower baseline strain values than SR patients.
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Affiliation(s)
- Aslannif Roslan
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia.
| | - Faten A Aris
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Tey Yee Sin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Afif Ashari
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Abdul A Shaparudin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Wan Faizal W Rahimi Shah
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Lee Tjen Jhung
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | - Koh Hui Beng
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
| | | | - Amin Ariff Nuruddin
- Department of Cardiology, Institut Jantung Negara, 145, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia
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Samaan AA, Said K, Aroussy WE, Hassan M, Romeih S, El Sawy A, Fawzy ME, Yacoub M. Left Ventricular Remodeling Following Balloon Mitral Valvuloplasty in Rheumatic Mitral Stenosis: Magnetic Resonance Imaging Study. Front Cardiovasc Med 2021; 8:674435. [PMID: 34150869 PMCID: PMC8212956 DOI: 10.3389/fcvm.2021.674435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Rheumatic heart disease affects primarily cardiac valves, it could involve the myocardium either primarily or secondary to heart valve affection. The influence of balloon mitral valvuloplasty (BMV) on left ventricular function has not been sufficiently studied. Aim: To determine the influence of balloon mitral valvuloplasty (BMV) on both global and regional left ventricular (LV) function. Methods: Thirty patients with isolated rheumatic mitral stenosis (MS) were studied. All patients had cardiac magnetic resonance imaging (CMR) before, 6 months and 1 year after successful BMV. LV volumes, ejection fraction (EF), regional and global LV deformation, and LV late gadolinium enhancement were evaluated. Results: At baseline, patients had median EF of 57 (range: 45-69) %, LVEDVI of 74 (44-111) ml/m2 and LVESVI of 31 (14-57) ml/m2 with absence of late gadolinium enhancement in all myocardial segments. Six months following BMV, there was a significant increase in LV peak systolic global longitudinal strain (GLS) (-16.4 vs. -13.8, p < 0.001) and global circumferential strain (GCS) (-17.8 vs. -15.6, p = 0.002). At 1 year, there was a trend towards decrease in LVESVI (29 ml/m2, p = 0.079) with a significant increase in LV EF (62%, p < 0.001). A further significant increase, compared to 6 months follow up studies, was noticed in GLS (-17.9 vs. -16.4, p = 0.008) and GCS (-19.4 vs. -17.8 p = 0.03). Conclusions: Successful BMV is associated with improvement in global and regional LV systolic strain which continues for up to 1 year after the procedure.
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Affiliation(s)
- Amir Anwar Samaan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Karim Said
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Wafaa El Aroussy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Mohammed Hassan
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Soha Romeih
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Amr El Sawy
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Mohammed Eid Fawzy
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Cairo, Egypt
| | - Magdi Yacoub
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
- Department of Cardiothoracic Surgery, Imperial College London, London, United Kingdom
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Samaan AA, Said K, El Aroussy W, Hassan M, Romeih S, Al Sawy A, Fawzy ME, Yacoub M. Impact of balloon mitral valvuloplasty on left ventricular rotational deformation: Magnetic Resonance Imaging follow up study. Int J Cardiovasc Imaging 2020; 36:1543-1550. [PMID: 32328870 DOI: 10.1007/s10554-020-01856-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/17/2020] [Indexed: 11/25/2022]
Abstract
In patients with rheumatic mitral stenosis (MS), some previous studies have investigated the influence of balloon mitral valvuloplasty (BMV) on left ventricular (LV) systolic function. However, the impact of BMV on LV twisting motion in this clinical setting has not been studied before yet. To describe changes in LV torsion in patients with rheumatic MS following BMV. Thirty patients (median age 33 years, 22 women) with isolated severe MS were studied. CMR myocardial tissue tagging was used for assessment of LV rotational deformation. LV torsion was calculated as the twist value (the net difference between apical counterclockwise and basal clockwise rotation) normalized to the length of the ventricle and multiplied by the mean radius at the base and apex. All patients had CMR studies before, 6 months and 1 year after successful BMV. At baseline, patients had a mitral valve area of 0.9 (0.6-1.3) cm2, mean pressure gradient of 12.5 (8-24) mmHg across the valve as measured by transthoracic echocardiography. Median LV ejection fraction (LVEF) estimated by CMR was 57 (range: 45-69) %. A significant improvement in LV base-apex torsion was shown at 6 months (3.3° vs. 2.5°, p < 0.001) with a further improvement at 1 year (4.1° vs. 3.3°, p = 0.05). Similar pattern of change was seen in LV base-mid torsion with a significant increase at 6 months (3.6° vs. 2.3°, p < 0.001) and a further increase at 1 year (4.7° vs. 3.6°, p = 0.007). These changes were associated with a significant increase in LVEF (62% vs. 57%, p < 0.001) at 1 year following BMV. Successful BMV is associated with a significant improvement in LV torsion that is accompanied by a significant improvement in LVEF.
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Affiliation(s)
- Amir Anwar Samaan
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt.
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt.
| | - Karim Said
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Wafaa El Aroussy
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Mohamed Hassan
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
- Department of Cardiology, Aswan Heart Centre, Aswan, Egypt
| | - Soha Romeih
- Department of Radiology, Aswan Heart Centre, Aswan, Egypt
| | - Amr Al Sawy
- Department of Radiology, Aswan Heart Centre, Aswan, Egypt
| | - Mohamed Eid Fawzy
- Department of Cardiovascular Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Kasr Al Aini Street, Cairo, 11956, Egypt
| | - Magdi Yacoub
- Department of Cardiothoracic Surgery, Aswan Heart Centre, Aswan, Egypt
- Department of Cardiothoracic Surgery, Imperial College London, London, UK
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Lloyd G, Badiani S, Costa M, Armado K, Bhattacharyya S. Mitral stenosis in 2019: changing approaches for changing times. Expert Rev Cardiovasc Ther 2019; 17:473-477. [PMID: 31195847 DOI: 10.1080/14779072.2019.1632190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guy Lloyd
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute , Queen Mary & Westfield, University of London , London , UK.,d Institute of Cardiovascular Sciences , UCL , London , UK
| | - Sveeta Badiani
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Marta Costa
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Karen Armado
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Sanjeev Bhattacharyya
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute , Queen Mary & Westfield, University of London , London , UK.,d Institute of Cardiovascular Sciences , UCL , London , UK
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Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study. Int J Cardiovasc Imaging 2017; 33:1323-1330. [DOI: 10.1007/s10554-017-1109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 03/03/2017] [Indexed: 11/28/2022]
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8
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Barros-Gomes S, Eleid MF, Dahl JS, Pislaru C, Nishimura RA, Pellikka PA, Pislaru SV. Predicting outcomes after percutaneous mitral balloon valvotomy: the impact of left ventricular strain imaging. Eur Heart J Cardiovasc Imaging 2016; 18:763-771. [DOI: 10.1093/ehjci/jew160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 07/06/2016] [Indexed: 01/19/2023] Open
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9
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Younan H. Role of two dimensional strain and strain rate imaging in assessment of left ventricular systolic function in patients with rheumatic mitral stenosis and normal ejection fraction. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Karagöz A, Bezgin T, Kutlutürk I, Külahçıoğlu S, Tanboğa IH, Güler A, Karabay CY, Oduncu V, Aksoy H, Kırma C. Subclinical left ventricular systolic dysfunction in diabetic patients and its association with retinopathy: A 2D speckle tracking echocardiography study. Herz 2014; 40 Suppl 3:240-6. [PMID: 25205476 DOI: 10.1007/s00059-014-4138-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 07/02/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
AIM It is important to diagnose diabetic cardiomyopathy in the early stages to prevent development of evident heart failure in the future. The primary objective of this study was to evaluate the presence of subclinical left ventricular (LV) dysfunction with two-dimensional (2D) speckle tracking echocardiography (STE) and the secondary objective was to compare retinopathy-positive and -negative diabetic patients. PATIENTS AND METHODS A total of 82 patients with type II diabetes mellitus (DM) and 90 gender-matched healthy controls were included. Retinopathy was present in 55 patients in the study group. All study participants underwent conventional 2D echocardiography and STE. RESULTS All diabetic patients had preserved LV ejection fraction (LV-EF ≥ 50). Compared with the control group, diabetic patients had a larger left atrium (47.3 ± 19.9 mm vs. 36.9 ± 17.8 mm, p < 0.001) and a higher E/Em ratio (12.0 ± 2.9 vs. 10.5 ± 3.7, p = 0.004). The LV-EF, LV end diastolic and end systolic volumes, E/A ratios, deceleration times, and tissue Doppler parameters were compared between groups. The study group was observed to have statistically significant lower four-chamber (4C; 17.7 ± 3.0 % vs. 19.3 ± 3.5 %, p = 0.002), three-chamber (3C; 17.5 ± 3.0 % vs. 19.2 ± 3.4 %, p = 0.001), and two-chamber (2C; 18.5 ± 3.5 % vs. 20.1 ± 2.4 %, p = 0.001) peak longitudinal strain values compared with the control group. Moreover, LV global strain values were found to be significantly lower in the DM group than in the control group (17.9 ± 2.7 % vs. 21.1 ± 3.2 %, p < 0.001). By contrast, basal rotation (4.9 ± 3.3° vs.2.8 ± 4.5°, p = 0.001), apical rotation (15.3 ± 6.7° vs. 12.1 ± 5.3°, p = 0.001) and LV twist (20.2 ± 7.2° vs. 16.9 ± 6.5°, p = 0.002) in the DM group were significantly increased compared with those of controls. CONCLUSION The STE procedure can be a useful novel technique in the determination of subclinical LV dysfunction in diabetic patients. Diabetic patients have lower longitudinal myocardial mechanics, and circumferential and rotational mechanics are impaired. There was no significant association between diabetic retinopathy and LV function.
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Affiliation(s)
- A Karagöz
- Cardiology Clinic, Kartal Koşuyolu Heart Research Hospital, Denizer Cad. Cevizli Kartal, 34846, Istanbul, Turkey
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11
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Sengupta SP, Amaki M, Bansal M, Fulwani M, Washimkar S, Hofstra L, Narula J, Sengupta PP. Effects of Percutaneous Balloon Mitral Valvuloplasty on Left Ventricular Deformation in Patients with Isolated Severe Mitral Stenosis: A Speckle-Tracking Strain Echocardiographic Study. J Am Soc Echocardiogr 2014; 27:639-47. [DOI: 10.1016/j.echo.2014.01.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Indexed: 11/29/2022]
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12
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Bilen E, Kurt M, Tanboga IH, Kaya A, Isik T, Ekinci M, Can MM, Karakas MF, Oduncu V, Bayram E, Aksakal E, Sevimli S. Severity of mitral stenosis and left ventricular mechanics: a speckle tracking study. Cardiology 2011; 119:108-15. [PMID: 21912124 DOI: 10.1159/000330404] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 06/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND It has been shown that mitral stenosis (MS) impairs left ventricular (LV) systolic function; however, this issue has not been studied comprehensively. We aimed to evaluate the role of 2D strain in the assessment of subclinical LV systolic dysfunction in patients with MS. METHODS Seventy-two patients with isolated MS (mild, moderate and severe) and 31 healthy control subjects constituted the study population. 2D echocardiography images were obtained from LV apical 4-chamber (4C), long axis (LAX), and 2-chamber (2C) views. Peak longitudinal strain and strain rate (Sr) were obtained from 4C, LAX, and 2C views. Global strain and Sr were calculated by averaging the three apical views. RESULTS There were no significant differences in LV ejection fraction and LV systolic or diastolic dimensions between the groups. Patients with MS had significantly lower LV longitudinal strain and Sr measurements than the control group. In addition, there were no significant differences in MS subgroups with respect to LV strain and Sr measurements. CONCLUSION We demonstrated that patients with MS had lower LV functions using 2D strain imaging, and this is independent of the hemodynamic severity of MS. In the detection of subclinical LV dysfunction in patients with MS, 2D strain imaging appears to be useful.
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Affiliation(s)
- Emine Bilen
- Ankara Ataturk Education and Research Hospital, Ankara, Turkey
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Sengupta SP, Sengupta PP, Narula J. Echocardiographic Investigations of Myocardial Function in Mitral Stenosis: Making Sense of the Echolalia. Cardiology 2011; 119:142-4. [DOI: 10.1159/000331404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2011] [Indexed: 11/19/2022]
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14
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Yuce M, Davutoglu V, Ozbala B, Ercan S, Kizilkan N, Akcay M, Sari I, Akkoyun C, Dogan A, Alici MH, Yavuz F. Fragmented QRS is predictive of myocardial dysfunction, pulmonary hypertension and severity in mitral stenosis. TOHOKU J EXP MED 2010; 220:279-83. [PMID: 20383039 DOI: 10.1620/tjem.220.279] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Reliable non-invasive new indices reflecting severity of rheumatic valve disease would be highly beneficial. Recently, presence of fragmented QRS (fQRS) in ECG was accepted as a marker of myocardial fibrosis. fQRS is defined as the presence of RSR' patterns such as additional R wave (R'), notching in the R wave or the S wave in 2 contiguous leads. Purpose of our study was to establish frequency of fQRS in isolated rheumatic mitral stenosis compared with control group. We studied 193 patients with mitral stenosis and age/gender matched 97 healthy subjects. Patients were categorized according to the New York Heart Association (NYHA) functional class. Severity of mitral stenosis, left ventricular ejection fraction, and pulmonary artery pressure were obtained by means of echocardiography. fQRS was defined on routine 12-lead ECG. fQRS was more frequent in subjects with mitral stenosis than in control group (p < 0.001). fQRS was associated with low ejection fraction, pulmonary hypertension, poor functional NYHA class, increased mean mitral valve gradient and decreased mitral valve area (R = 0.1, p = 0.02; R = 0.1, p = 0.001; R = 0.1, p = 0.01; R = 0.1, p = 0.04; and R = -0.1, p = 0.009, respectively). Mitral valve area was the only independent predictor of fQRS in multiple logistic regression analysis. In conclusion, fQRS is predictive of severe mitral stenosis, lower ejection fraction, increased pulmonary artery pressure, and poor functional class. fQRS might be considered as a novel indicator of mitral stenosis severity and associated complications.
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Affiliation(s)
- Murat Yuce
- Cardiology Department, Gaziantep University, School of Medicine, Gaziantep, Turkey
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15
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Emerging clinical role of strain imaging in echocardiography. Heart Lung Circ 2010; 19:161-74. [PMID: 20149727 DOI: 10.1016/j.hlc.2009.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 11/24/2009] [Indexed: 01/07/2023]
Abstract
Myocardial strain is a measure of tissue deformation and strain rate is the rate at which deformation occurs. When applied to the heart, strain and strain rate give fundamental information on myocardial properties and mechanics that would otherwise be unavailable. Site specificity and angle independency are two unique characteristics of strain and strain rate data. Strain and strain rate can be obtained with tissue Doppler imaging or with 2D speck tracking. These two techniques derive information on strain and strain rate in two fundamentally different ways and each has its own advantages and limitations. Tissue Doppler imaging yields velocity information from which strain and strain rate are mathematically derived whereas 2D speckle tracking yields strain information from which strain rate and velocity data are derived. Data obtained from these two different techniques may not be equivalent due to limitations inherent with each technique. Strain and strain rate imaging have been used to assess myocardial function in a wide range of cardiac conditions. They are useful in detecting early left ventricular (LV) dysfunction in the setting of systemic diseases with cardiac involvement, in differentiating transmural from non-transmural infarction, and in identifying LV contractile reserve in regurgitant valve lesions. When used with dobutamine echocardiography, strain and strain rate imaging can identify viable myocardium and aid the detection of myocardial ischaemia. Strain and strain rate imaging can also be used to assess right ventricular and left atrial function. Despite significant promises, strain and strain rate imaging is technically challenging and signal to noise ratio may be potentially affected by a wide range of factors. As a result, strain and strain rate imaging have been slow to get incorporated into everyday clinical practice. Ongoing research and further technical development are likely to improve the quality of the data and the more general acceptance of these new modalities of imaging in echocardiography.
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Ozdemir AO, Kaya CT, Ozcan OU, Ozdol C, Candemir B, Turhan S, Dincer I, Erol C. Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis. Int J Cardiovasc Imaging 2009; 26:397-404. [PMID: 19967561 DOI: 10.1007/s10554-009-9550-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 11/26/2009] [Indexed: 10/20/2022]
Abstract
Longitudinal two-dimensional strain deformation is a novel technique which evaluates global and regional left ventricular (LV) function with high reproducibility. The aim of the study was to investigate the global and regional systolic function using this method in patients with pure mitral stenosis (MS). Conventional echocardiography and longitudinal two-dimensional strain analysis were performed in 60 patients (41 +/- 5 years, 48 women) with mild to moderate MS (mitral valve area: 1.9 +/- 0.5 cm(2)), and 52 healthy controls (40 +/- 7 years, 37 women). For strain analysis standard apical views were obtained, and by using a software system peak systolic strain and strain rate were calculated off-line in each segment. In all, 88% of the segments could be optimally tracked by the software system. Despite normal LV systolic function as assessed by ejection fraction (66 +/- 8%), mean global longitudinal strain (GLS) and global longitudinal strain rate (GLSR) were significantly reduced in patients with isolated MS (GLS -17 +/- 3.3 vs. -19 +/- 2.5%, P = 0.006 and GLSR -1.3 +/- 0.3 vs. -1.5 +/- 0.3 s(-1), P < 0.0001). Regional analysis demonstrated that patients with MS had a significantly reduced longitudinal peak strain and strain rate in all basal, and some mid (inferior, anteroseptal, interventricular septum) segments of the left ventricle. For other segments longitudinal peak strain and strain rate values were similar among the groups. Evaluation of LV systolic function by longitudinal two-dimensional strain deformation identified early abnormalities in MS patients who had apparently normal standard systolic function.
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Affiliation(s)
- Aydan Ongun Ozdemir
- Department of Cardiology, School of Medicine, Ankara University, 31 Sokak 5/12 Bahcelievler, 06490, Ankara, Turkey.
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Abstract
Mitral stenosis is a common disease that causes substantial morbidity worldwide. The disease is most prevalent in developing countries, but is increasingly being identified in an atypical form in developed countries. All treatments that increase valve area improve morbidity. Mortality improves with surgery; the benefit of percutaneous balloon valvuloplasty to mortality might be similar to that of surgery but needs further study. Percutaneous balloon valvuloplasty is the treatment of choice for patients in whom treatment is indicated, except for those with suboptimum valve morphology, and even these patients are sometimes treated with this procedure if surgery is not feasible or if surgical risk is prohibitive. We review the pathology, diagnosis, and treatment options for patients with mitral stenosis.
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Affiliation(s)
- Y Chandrashekhar
- Veterans Affairs Medical Center and University of Minnesota, Minneapolis, MN 55417, USA.
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Left Ventricular Mechanics in Idiopathic Dilated Cardiomyopathy: Systolic-Diastolic Coupling and Torsion. J Am Soc Echocardiogr 2009; 22:486-93. [DOI: 10.1016/j.echo.2009.02.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Indexed: 11/24/2022]
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Dray N, Balaguru D, Pauliks LB. Abnormal left ventricular longitudinal wall motion in rheumatic mitral stenosis before and after balloon valvuloplasty: a strain rate imaging study. Pediatr Cardiol 2008; 29:663-6. [PMID: 17786377 DOI: 10.1007/s00246-007-9047-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 07/17/2007] [Accepted: 08/07/2007] [Indexed: 10/22/2022]
Abstract
Rheumatic mitral stenosis may be associated with left ventricular dysfunction. We report improvements of abnormal longitudinal wall motion and strain rate post-balloon valvuloplasty of severe mitral stenosis in a girl with normal ejection fraction.
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Affiliation(s)
- Nicole Dray
- Tufts-New England Medical Center, Boston, MA 02111, USA
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Speckle tracking echocardiography - a new tool for quantification of myocardial function. COR ET VASA 2008. [DOI: 10.33678/cor.2008.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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