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Mihara K, Kanemoto I, Sato K, Yasuhira Y, Watanabe I, Suzuki Y, Nagura J, Misumi K. Effects of mitral valve repair on valvular geometry and hemodynamics in dogs with myxomatous mitral valve disease. Vet Surg 2024; 53:415-425. [PMID: 38205863 DOI: 10.1111/vsu.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To investigate the effects of mitral valve repair on the geometry of the mitral valve complex, hemodynamics, and cardiac function of dogs with myxomatous mitral valve disease (MMVD). STUDY DESIGN Retrospective cohort study. SAMPLE POPULATION Dogs (n = 77) with stage C MMVD undergoing mitral valve repair under cardiopulmonary bypass. METHODS Mitral valve geometry and cardiac function were assessed using echocardiography preoperatively, 1 week postoperatively and 3 months postoperatively. RESULTS The coaptation length (0 [0-0] vs. 7 [6-8.5] mm, p < .001) and forward stroke volume index (1.5 ± 0.4 vs. 2.3 ± 0.6 mL/kg, p < .001) were higher at 3-months postoperatively than preoperatively, whereas the vertebral heart score (12.3 ± 1.2 vs. 10.8 ± 0.8 V, p < .001), left atrial-to-aortic ratio (2.2 ± 0.7 vs. 1.2 ± 0.3, p < .001), peak velocity of early diastolic transmitral flow (144 ± 34 vs. 91 ± 18 cm/s, p < .001), and regurgitant volume index (11.3 [8.2-14.0] vs. 1.6 [0.95-2.35] mL/kg, p < .001) were lower. Postoperatively, mitral valve geometry was completely changed within 1 week, whereas changes in vertebral heart score lasted for 3 months. CONCLUSION Mitral valve repair changed valvular geometry and improved hemodynamics as assessed by follow-up echocardiography. CLINICAL SIGNIFICANCE This study acts as reference for surgeons and cardiologists considering or evaluating the effects of mitral valve repair in dogs and provides useful data for the enhancement of relevant surgical techniques and the selection of relevant pre- and postoperative observations.
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Affiliation(s)
- Kippei Mihara
- Joint Graduate School of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
- Chayagasaka Animal Hospital, Nagoya, Japan
| | | | | | | | | | | | | | - Kazuhiro Misumi
- Joint Graduate School of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
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Takada T, Nakata Y, Matsuura K, Minami Y, Kishihara M, Watanabe S, Shirotani S, Abe T, Yoshida A, Hasegawa S, Jujo K, Arai K, Suzuki A, Hagiwara N, Yamaguchi J. Left Ventricular End-Systolic Diameter May Predict Persistent Heart Failure with Reduced Ejection Fraction. Int Heart J 2023; 64:1095-1104. [PMID: 37967983 DOI: 10.1536/ihj.23-293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Patients with persistent heart failure (HF) with reduced ejection fraction (HFrEF) have a poorer prognosis than those with HF with improved ejection fraction (HFimpEF). However, data on the predictive value of echocardiographic parameters for persistent HFrEF are lacking. We retrospectively studied 443 patients who were diagnosed with HFrEF (EF ≤ 40%) during hospitalization and underwent echocardiography at the 1-year follow-up. We divided them into the 2 groups: HFimpEF (EF > 40%) and persistent HFrEF group at 1-year follow-up, and assessed the predictive value of echocardiographic parameters at discharge for persistent HFrEF. In total, 301/443 patients (68%) were diagnosed with persistent HFrEF and 142/443 (32%) with HFimpEF at the 1-year follow-up. Kaplan-Meier analysis revealed that the persistent HFrEF group had a poorer prognosis than the HFimpEF group (log-rank, P < 0.001). Receiver operating characteristic curve analysis revealed that left ventricular end-systolic diameter (LVESD) had the highest area under the curve (AUC) (0.70; 95% confidence interval [CI]: 0.64-0.75; cutoff value: 55 mm) among various echocardiographic parameters. LVESD was an independent predictor of persistent HFrEF at the 1-year follow-up (odds ratio: 1.07, 95%CI: 1.02-1.12) upon multivariable logistic regression analysis. The incidence of persistent HFrEF was higher in patients with an LVESD ≥ 55 mm than in those with an LVESD < 55 mm (81% versus 55%, Fisher's exact test, P < 0.001). In conclusion, an LVESD (≥ 55 mm) was associated with persistent HFrEF. Focusing on LVESD in daily practice may help clinicians with risk stratification for decision-making regarding management in patients with advanced HF refractory to guideline-directed medical therapy.
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Affiliation(s)
- Takuma Takada
- Department of Cardiology, Tokyo Women's Medical University
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | - Yuki Nakata
- Department of Cardiology, Tokyo Women's Medical University
| | - Katsuhisa Matsuura
- Department of Cardiology, Tokyo Women's Medical University
- Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University
| | | | | | | | | | - Takuro Abe
- Department of Cardiology, Tokyo Women's Medical University
| | - Ayano Yoshida
- Department of Cardiology, Tokyo Women's Medical University
| | - Shun Hasegawa
- Department of Cardiology, Tokyo Women's Medical University
| | - Kentaro Jujo
- Department of Cardiology, Tokyo Women's Medical University
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women's Medical University
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Impact of mitral regurgitation on left ventricular remodeling and function in children with rheumatic heart disease. Int J Cardiovasc Imaging 2022; 38:2667-2676. [DOI: 10.1007/s10554-022-02678-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 06/15/2022] [Indexed: 11/25/2022]
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Kang Y, Yang ZX, Liu LL, Kong H, Wang H, Dong W, Bai L, Wang J, Sun ZJ, Zhang J, Li J, Guo YQ, Zhang Q. ARNI or ARB Treats Residual Left Ventricular Remodelling after Surgery for Valvular Regurgitation: ReReRe study protocol. ESC Heart Fail 2022; 9:3585-3592. [PMID: 35822565 DOI: 10.1002/ehf2.14058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 05/13/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS Patients with persistent or de novo left ventricular (LV) dilation and/or reduced ejection fraction (EF) after correction for primary aortic (AR) or mitral (MR) regurgitation (i.e. residual LV remodelling) have not been well studied with regard to guideline-directed medical therapy after successful aetiology-reversing surgery. We aim to (i) compare the effectiveness of sacubitril/valsartan vs. valsartan in promoting LV reverse remodelling and (ii) explore the safety of medication withdrawal after LV recovery. METHODS AND RESULTS The ReReRe study is a multicentre, randomized, open-label, parallel trial that consists of two consecutive parts. A total of 371 patients with an LV end-diastolic diameter (LVEDD) > 60 mm or LVEF < 50%, assessed by transthoracic echocardiography (TTE) 7-14 days after valve surgery for significant AR or primary MR will be enrolled. The 1st randomization into the sacubitril/valsartan or valsartan groups and structured follow-up (1, 3, 6, 9, and 12 months after randomization) will be conducted to observe the primary objective as the rate of complete recovery of LV remodelling (i.e. LVEDD < 55 mm and LVEF ≥ 60% by TTE at two consecutive visits). Those who have complete recovery of LV remodelling will be enrolled in Study Part 2; consequently, they will receive the 2nd randomization into the medication withdrawal or maintenance group and 6-monthly visits for the observation of the primary objective as the rate of LV remodelling relapse (LVEDD > 60 mm or LVEF < 50%). The secondary objectives include the rate of composite clinical outcomes and the degree of change in 6-min walk distance and Kansas City Cardiomyopathy Questionnaire scores. CONCLUSIONS The ReReRe study will provide new evidence for the treatment of patients with residual LV remodelling after curable unloaded surgery, as well as the duration of treatment. The study results will fill the gap in identifying an appropriate medical therapy regimen for this group of patients and perhaps for those with reversible aetiologies of heart failure.
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Affiliation(s)
- Yu Kang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Zi-Xuan Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lu-Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Kong
- The Heart Failure Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Dong
- Department of Cardiology, The Chinese PLA General Hospital (301 Hospital), Beijing, China
| | - Ling Bai
- Department of Cardiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiang Wang
- Department of Cardiology, Xinqiao Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zhi-Jun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Zhang
- Department of Cardiology, Heart Center of Henan Provincial People's Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Hibino M, Dhingra NK, Chan V, Mazer CD, Teoh H, Quan A, Verma R, Leong-Poi H, Bisleri G, Connelly KA, Verma S. Stage-based approach to predict left ventricular reverse remodeling after mitral repair. Clin Cardiol 2022; 45:921-927. [PMID: 35748086 PMCID: PMC9451668 DOI: 10.1002/clc.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision‐making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet. Methods and Results The CAMRA CardioLink‐2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end‐systolic volume (LVESVI), indexed left ventricular end‐diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique. Conclusions Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeon Ireland, Dublin, Ireland
| | - Howard Leong-Poi
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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Bernard J, Altes A, Dupuis M, Toubal O, Mahjoub H, Tastet L, Côté N, Clavel MA, Dumortier H, Tartar J, O'Connor K, Bernier M, Beaudoin J, Maréchaux S, Pibarot P. Cardiac Damage Staging Classification in Asymptomatic Moderate or Severe Primary Mitral Regurgitation. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100004. [PMID: 37273475 PMCID: PMC10236891 DOI: 10.1016/j.shj.2022.100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/09/2021] [Accepted: 12/13/2021] [Indexed: 06/06/2023]
Abstract
Background Optimal timing for intervention remains uncertain in asymptomatic patients with primary mitral regurgitation (MR). We aimed to assess the prognostic value of a new cardiac damage staging classification in patients with asymptomatic moderate or severe primary MR. Methods Clinical, Doppler-echocardiographic, and outcome data prospectively collected in 338 asymptomatic patients (64 ± 15 years, 68% men) with at least moderate primary MR were retrospectively analyzed. Patients were hierarchically classified as per the following staging classification: no cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate or severe left ventricular or left atrial damage (stage 2), pulmonary vasculature or tricuspid valve damage (stage 3), or right ventricular damage (stage 4). Results There was a stepwise increase in 10-year mortality rates as per cardiac damage stage: 20.0% in stage 0, 25.6% in stage 1, 31.5% in stage 2, and 61.3% in stage 3-4 (p < 0.001). The staging classification was significantly associated with increased risk of mortality (hazard ratio = 1.41 per one-stage increase, 95% confidence interval: 1.07-1.85, p = 0.015) and the composite of cardiovascular mortality or hospitalization (hazard ratio = 1.51 per one-stage increase, 95% confidence interval: 1.07-2.15, p = 0.020) in multivariable analysis adjusted for EuroSCORE II, mitral valve intervention as a time-dependent variable, and other risk factors. The proposed scheme showed incremental value over several clinical variables (net reclassification index = 0.40, p = 0.03). Conclusions The new staging classification provides independent and incremental prognostic value in patients with asymptomatic moderate or severe MR.
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Affiliation(s)
- Jérémy Bernard
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Alexandre Altes
- Department of Cardiology, Institut Catholique de Lille / Catholic Institute of Lille, Université Catholique de Lille / Catholic University of Lille, Lille France
| | - Marlène Dupuis
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Oumhani Toubal
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Haïfa Mahjoub
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Lionel Tastet
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Nancy Côté
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Hélène Dumortier
- Department of Cardiology, Institut Catholique de Lille / Catholic Institute of Lille, Université Catholique de Lille / Catholic University of Lille, Lille France
| | - Jean Tartar
- Department of Cardiology, Institut Catholique de Lille / Catholic Institute of Lille, Université Catholique de Lille / Catholic University of Lille, Lille France
| | - Kim O'Connor
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Mathieu Bernier
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
| | - Sylvestre Maréchaux
- Department of Cardiology, Institut Catholique de Lille / Catholic Institute of Lille, Université Catholique de Lille / Catholic University of Lille, Lille France
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec/Québec Heart & Lung Institute, Université Laval / Laval University, Québec City, Québec, Canada
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Li Q, Zhang Y, Huang H, Chen W, Shi S, Chen S, Wang B, Lai W, Huang Z, Luo Z, Chen J, Tan N, Liu J, Liu Y. Are There Any Differences in the Prognostic Value of Left Ventricular Ejection Fraction in Coronary Artery Disease Patients With or Without Moderate and Severe Mitral Regurgitation? Front Cardiovasc Med 2022; 9:799253. [PMID: 35310991 PMCID: PMC8930921 DOI: 10.3389/fcvm.2022.799253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is a vital variable to describe left ventricle systolic function and contractility of left ventricle. However, the association between LVEF and the prognostic effect in patients with moderate or severe mitral regurgitation (MR) is still controversial. Methods This study comprised 30,775 coronary artery disease (CAD) patients who underwent coronary arteriography (CAG) in the Cardiorenal ImprovemeNt (CIN) registry from January 2007 to December 2018. Patients were divided into none or mild MR group and moderate or severe MR group, and 3 levels of LVEF ≥50, 40–50%, and <40% were further distinguished according to hospital baseline. Univariate and multivariate Cox proportional analyses were used to investigate the association between LVEF levels and long-term all-cause mortality in patients with different MR severities. Results Of 30,775 CAD patients (62.9 ± 10.6 years, females 23.8%), 26,474 (86.0%) patients had none or mild MR. Compared with none or mild MR patients, patients with moderate or severe MR were older and had worse cardio-renal function. In multivariable Cox proportional analysis, LVEF <40% was independently associated with higher mortality compared with LVEF ≥ 50% in all kinds of MR severity {none or mild MR [adjusted hazard ratio (HR): 1.79; 95% CI: 1.56–2.05, p < 0.001], moderate or severe MR [adjusted HR: 1.57; 95% CI: 1.29–1.91, p < 0.001]}. Conclusions LVEF is a reliable prognostic index in CAD patients, even in those with moderate or severe MR. LVEF monitoring would still be clinically useful in CAD patients with moderate or severe MR. Clinical trials are needed to prospectively evaluate the optimal threshold for LVEF in patients with moderate or severe MR.
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Affiliation(s)
- Qiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifei Zhang
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihua Chen
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shanshan Shi
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenguang Lai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiling Luo
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jin Liu
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu
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Blissett S, Agrawal H, Kheiwa A, Caughron H, Harris IS, Agarwal A, Foster E, Mallawaarachchi I, Mahadevan VS. Cardiac remodeling in adults following percutaneous PDA closure: A meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kim J, Nam JS, Kim Y, Chin JH, Choi IC. Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation. J Clin Med 2021; 10:jcm10143013. [PMID: 34300179 PMCID: PMC8306203 DOI: 10.3390/jcm10143013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.
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Affiliation(s)
| | | | | | - Ji-Hyun Chin
- Correspondence: ; Tel.: +82-2-3010-5632; Fax: +82-2-3010-6790
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Changes in Left Ventricular Ejection Fraction after Mitral Valve Repair for Primary Mitral Regurgitation. J Clin Med 2021; 10:jcm10132830. [PMID: 34206958 PMCID: PMC8267705 DOI: 10.3390/jcm10132830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
This study sought to identify the short- and long-term changes in left ventricular ejection fraction (LVEF) after mitral valve repair (MVr) in patients with chronic primary mitral regurgitation according to preoperative LVEF (pre-LVEF) and preoperative left ventricular end-systolic diameter (pre-LVESD). This study evaluated 461 patients. Restricted cubic spline regression models were constructed to demonstrate the long-term changes in postoperative LVEF (post-LVEF). The patients were divided into four groups according to pre-LVEF (<50%, 50–60%, 60–70%, and ≥70%). The higher the pre-LVEF was, the greater was the decrease in LVEF immediately after MVr. In the same pre-LVEF range, immediate post-LVEF was lower in patients with pre-LVESD ≥ 40 mm than in those with pre-LVESD < 40 mm. The patterns of long-term changes in post-LVEF differed according to pre-LVEF (p for interaction < 0.001). The long-term post-LVEF reached a plateau of approximately 60% when the pre-LVEF was ≥50%, but it seemed to show a downward trend after reaching a peak at approximately 3–4 years after MVr when the pre-LVEF was ≥70%. The patterns of short- and long-term changes in post-LVEF differed according to pre-LVEF and pre-LVESD values in patients with chronic primary mitral regurgitation after MVr.
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11
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Modaragamage Dona AC, Afoke J, Punjabi PP, Kanaganayagam GS. Global longitudinal strain to determine optimal timing for surgery in primary mitral regurgitation: A systematic review. J Card Surg 2021; 36:2458-2466. [PMID: 33783012 DOI: 10.1111/jocs.15521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary mitral regurgitation (PMR) results in adverse remodeling changes and left ventricular (LV) dysfunction. Assessing LV function has prognostic value in predicting morbidity and mortality. Indications for surgery include parameters such as LV ejection fraction (LVEF) and systolic dimensions. Current guidelines are limited in identifying patients at optimal time for surgery. Impaired postoperative LVEF indicates poor prognostic outcomes and subsequent heart failure. Global longitudinal strain (GLS) via speckle tracking echocardiography (STE) presents as a promising parameter to detect subclinical dysfunction in asymptomatic patients. METHODS Following PRISMA guidelines, a literature search was conducted with Cochrane Library, PudMed, SCOPUS, and Web of Science. Key MeSH terms included "mitral regurgitation," "mitral valve insufficiency," "global longitudinal strain," "deformation," "LV-GLS," and "GLS." Inclusion criteria included (1) patients with severe PMR, (2) mixed population of symptomatic and asymptomatic patients, (3) standardized methods in assessing LV systolic function using 2D-STE, (4) valve repair or replacement surgery, and (5) patient outcomes measured after surgery. Search returned 234 papers, 12 of which met the inclusion criteria and were subsequently reviewed. RESULTS Baseline GLS is an independent predictor of postoperative outcomes, ranging from -17.9 to -21.7% GLS. A significant negative correlation was observed between preoperative GLS and postoperative LVEF. Impaired baseline GLS was associated with higher mortality rates. Better long-term survival rates were seen in patients who underwent early surgery. CONCLUSION GLS shows sensitivity in predicting long-term postoperative outcomes. Further analysis is required to determine preoperative GLS threshold to identify asymptomatic patients at the optimal time for mitral valve surgery.
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Affiliation(s)
| | - Jonathan Afoke
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Prakash P Punjabi
- Department of Cardiothoracic Surgery, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Gajen S Kanaganayagam
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
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12
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Gajjar K, Kashyap K, Badlani J, Williams RB, Biederman RWW. A review of the pivotal role of cardiac MRI in mitral valve regurgitation. Echocardiography 2020; 38:128-141. [PMID: 33270944 DOI: 10.1111/echo.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
Cardiac imaging is the cornerstone of defining the etiology, quantification, and management of mitral regurgitation (MR). This continues to be even more so the case with emerging transcatheter techniques to manage MR. Transthoracic echocardiography remains the first-line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative nonvisual estimation, 3D volumetric data, late gadolinium, T1, and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling, and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.
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Affiliation(s)
- Kushani Gajjar
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Kartikeya Kashyap
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Jayshiv Badlani
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Ronald B Williams
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert W W Biederman
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Drexel University, Philadelphia, PA, USA.,Bioengineering Department, Carnegie Mellon University, Pittsburgh, PA, USA
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13
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Martin J, Coffey S, Whalley GA. Sex Disparity in Cardiovascular Disease Outcomes: Do Our Current Echocardiographic Reference Ranges Measure Up? Heart Lung Circ 2020; 30:e1-e5. [PMID: 33176982 DOI: 10.1016/j.hlc.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022]
Abstract
Reducing inequity in access to health care and disparity in health outcomes remain key objectives in cardiovascular medicine. Echocardiography is often the primary diagnostic tool used to detect cardiovascular disease (CVD), and relies on comparison with published reference ranges to appropriately detect pathology. Our understanding of the contribution of age, sex and ethnicity to quantification of cardiac size is improving, but cardiovascular disease management guidelines have yet to evolve. While recently, sex, age and ethnicity-specific reference values have been produced, treatment thresholds in many clinical guidelines do not differentiate between sexes. As a result, in order to reach management thresholds, women are often required to have more severe pathology. In order to reduce potential disadvantage to women, future research efforts should be directed to develop more personalised treatment approaches by identification of sex-appropriate management thresholds.
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Affiliation(s)
- Josh Martin
- Department of Cardiology, Sunshine Coast University Hospital, Sunshine Coast, QLD, Australia.
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian A Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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14
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Affiliation(s)
- Richard Paul Steeds
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK .,Honorary Reader, Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Saul G Myerson
- Cardiovascular Medicine, University of Oxford, Oxford, UK
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15
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Walmsley J, Squara P, Wolfhard U, Cornelussen R, Lumens J. Impact of abrupt versus gradual correction of mitral and tricuspid regurgitation: a modelling study. EUROINTERVENTION 2019; 15:902-911. [PMID: 31746755 DOI: 10.4244/eij-d-19-00598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Correction of mitral and/or tricuspid regurgitation (MR, TR) frequently leads to poor outcomes in the days following intervention. We sought to understand how abrupt correction of MR and TR affects ventricular load and to investigate if gradual correction is beneficial. METHODS AND RESULTS MR and TR were simulated using the CircAdapt cardiovascular system model with effective regurgitant orifice (ERO) areas of 0.5 cm2 and 0.7 cm2. Ventricular and atrial contractility reductions to 40% of normal and pulmonary hypertension were simulated. Abrupt and gradual ERO closure were simulated with homeostatic regulation of blood pressure and volume. Abrupt correction of MR increased left and right ventricular fibre stress by 40% and 15%, respectively, whereas TR correction increased left and right ventricular fibre stress by 26% and 19%, respectively. This spike was followed by a rapid drop in fibre stress. Myocardial dysfunction prolonged the spike but reduced its amplitude. Right ventricular fibre stress increased more with pulmonary hypertension and TR. Gradual correction demonstrated no spike in tissue load. CONCLUSIONS Simulations demonstrated that abrupt ERO closure creates a transient increase in ventricular load that is prolonged by worsened myocardial condition and exacerbated by pulmonary hypertension. Gradual closure of the ERO abolishes this spike and merits clinical investigation.
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Affiliation(s)
- John Walmsley
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
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16
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Santoro C, Galderisi M, Esposito R, Buonauro A, Monteagudo JM, Sorrentino R, Lembo M, Fernandez-Golfin C, Trimarco B, Zamorano JL. Global longitudinal strain is a hallmark of cardiac damage in mitral regurgitation: the Italian arm of the European Registry of mitral regurgitation (EuMiClip). Cardiovasc Ultrasound 2019; 17:28. [PMID: 31752893 PMCID: PMC6873488 DOI: 10.1186/s12947-019-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. METHODS Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). RESULTS LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. CONCLUSIONS Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy.
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Josè Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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17
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Li X, Bao K, Zhu R, Qi Q, Liu S, Li H, Song B. Predictors of early left ventricular dysfunction after mitral valve replacement for rheumatic valvular disease. J Card Surg 2019; 34:1185-1193. [PMID: 31441531 DOI: 10.1111/jocs.14215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the predictors of early left ventricular (LV) dysfunction in patients with rheumatic heart disease (RHD) after mitral valve replacement (MVR). We examined echocardiographic and nonechocardiographic predictors. METHODS This study included 571 patients receiving MVR for RHD from 2012 to 2017. Their baseline characters, preoperative examination, operation data, and postoperative echocardiography were collected retrospectively. Univariate and multivariate logistic regression were used to evaluate the predictors of early LV dysfunction after MVR. The LV dysfunction was defined as left ventricular end-ejection fraction (LVEF) <50%. The interaction model was further performed to calculate interaction effects between predictors selected by logistic regression. RESULTS In the 571 patients, 164 (28.7%) had early LV dysfunction after the operation, but only 94 (16.5%) had a preoperative LVEF <50%. Significant differences between two groups (LVEF ≥50% or LVEF <50%) were finally revealed in LV end-diastolic dimension, preoperative atrial fibrillation (AF), preoperative LVEF <50%, and the white blood cell (WBC) count measured after admission (>10 × 109 L -1 ) in the multivariate logistic regression. Corresponding odds ratios (ORs) were 1.06, 1.82, 3.63, and 2.64, respectively. Diabetes, lesion type, LV end-systolic dimension, aspartate transaminase, alanine transaminase, and serum creatinine were statistically significant (P < .05) in univariate logistic regression, with matched ORs 2.45, 1.66/0.65, 1.07, 2.50, 1.83, and 2.90, respectively. However, these variables were not significant anymore in the multivariate logistic model. Besides, the OR of early postoperative LV dysfunction increased to 7.00 when preoperative AF, preoperative LVEF <50%, and WBC >10 × 109 L-1 were all present. CONCLUSIONS The preoperative LV dysfunction, a large LV volume, AF and over-normal WBC could independently predict postoperative LV dysfunction.
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Affiliation(s)
- Xin Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Department of Cardiac Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Kaifang Bao
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, China
| | - Rongyan Zhu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Quan Qi
- Department of Cardiac Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Shidong Liu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Han Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Bing Song
- Department of Cardiac Surgery, The First Hospital of Lanzhou University, Lanzhou, China
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18
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Le Tourneau T, Topilsky Y, Inamo J, Mahoney DW, Suri R, Schaff HV, Sarano M. Reverse Left Ventricular Remodeling after Surgery in Primary Mitral Regurgitation: A Volume-Related Phased Process. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1639870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thierry Le Tourneau
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
- Institut du Thorax, Inserm, CNRS, Université de Nantes, Nantes, France
| | - Yan Topilsky
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jocelyn Inamo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W. Mahoney
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakesh Suri
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V. Schaff
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Maurice Sarano
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
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19
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Seldrum S, de Meester C, Pierard S, Pasquet A, Lazam S, Boulif J, Vanoverschelde JL, Gerber BL. Assessment of Left Ventricular Reverse Remodeling by Cardiac MRI in Patients Undergoing Repair Surgery for Severe Aortic or Mitral Regurgitation. J Cardiothorac Vasc Anesth 2019; 33:1901-1911. [DOI: 10.1053/j.jvca.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Indexed: 11/11/2022]
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20
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Liu B, Edwards NC, Pennell D, Steeds RP. The evolving role of cardiac magnetic resonance in primary mitral regurgitation: ready for prime time? Eur Heart J Cardiovasc Imaging 2019; 20:123-130. [PMID: 30364971 PMCID: PMC6343082 DOI: 10.1093/ehjci/jey147] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 09/16/2018] [Indexed: 12/26/2022] Open
Abstract
A fifth of patients with primary degenerative mitral regurgitation continue to present with de novo ventricular dysfunction following surgery and higher rates of heart failure, morbidity, and mortality. This raises questions as to why the left ventricle (LV) might fail to recover and has led to support for better LV characterization; cardiac magnetic resonance (CMR) may play a role in this regard, pending further research and outcome data. CMR has widely acknowledged advantages, particularly in repeatability of measurements of volume and ejection fraction, yet recent guidelines relegate its use to cases where there is discordant information or poor-quality imaging from echocardiography because of the lack of data regarding the CMR-based ejection fraction threshold for surgery and CMR-based outcome data. This article reviews the current evidence regarding the role of CMR in an integrated surveillance and surgical timing programme.
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Affiliation(s)
- Boyang Liu
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Nicola C Edwards
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Dudley Pennell
- CMR Unit, Royal Brompton Hospital, Sydney Street, London, UK
| | - Richard P Steeds
- Department of Cardiology, University Hospital Birmingham and Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham, UK
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21
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Báez-Ferrer N, Izquierdo-Gómez MM, Marí-López B, Montoto-López J, Duque-Gómez A, García-Niebla J, Miranda-Bacallado J, de la Rosa Hernández A, Laynez-Cerdeña I, Lacalzada-Almeida J. Clinical manifestations, diagnosis, and treatment of ischemic mitral regurgitation: a review. J Thorac Dis 2018; 10:6969-6986. [PMID: 30746243 DOI: 10.21037/jtd.2018.10.64] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ischemic mitral regurgitation (IMR) is a frequent complication after acute myocardial infarction (AMI) associated with a worse prognosis. The pathophysiological mechanisms of IMR are not fully understood, but it is known to be a complex process in which ventricular remodelling is the main causal factor. The various imaging techniques in cardiology and echocardiography fundamentally have contributed significantly to clarify the mechanisms that cause and progressively aggravate IMR. At present, different therapeutic options, the most important of which are cardio-surgical, address this problem. Nowadays the improvement in cardiac surgery and transcatheter therapies, have shown a therapeutic advance in IMR management. IMR is a predictor of poor prognosis in patients with heart failure and depressed left ventricular (LV) systolic function. However, it remains controversial whether mitral regurgitation (MR) in these patients is a consequence of dilation and dysfunction of the LV, or whether it contributes to worsening the prognosis of the ventricular dysfunction. Given that echocardiography has a fundamental reference role in the identification, graduation of severity and evaluation of the therapeutics used in the treatment of MR, we are going to focus on it over the rest of the imaging techniques. In contrast to primary MR the benefits of mitral surgery in patients with secondary MR are uncertain. Therefore, we will comment fundamentally on the role of mitral surgery in patients with IMR, with an update of the different surgical interventions available, without forgetting to mention the other therapeutic options currently available.
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Affiliation(s)
- Néstor Báez-Ferrer
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Belén Marí-López
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Javier Montoto-López
- Department of Cardiovascular Surgery, Hospital Universitario de Canarias, Tenerife, Spain
| | - Amelia Duque-Gómez
- Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, El Hierro, Spain
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22
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Inciardi RM, Rossi A, Benfari G, Cicoira M. Fill in the Gaps of Secondary Mitral Regurgitation: a Continuum Challenge From Pathophysiology to Prognosis. Curr Heart Fail Rep 2018; 15:106-115. [DOI: 10.1007/s11897-018-0379-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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23
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Uretsky S, Argulian E, Narula J, Wolff SD. Use of Cardiac Magnetic Resonance Imaging in Assessing Mitral Regurgitation. J Am Coll Cardiol 2018; 71:547-563. [DOI: 10.1016/j.jacc.2017.12.009] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/16/2017] [Accepted: 12/07/2017] [Indexed: 02/04/2023]
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24
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Niki K, Sugawara M, Kayanuma H, Takamisawa I, Watanabe H, Mahara K, Sumiyoshi T, Ida T, Takanashi S, Tomoike H. Associations of increased arterial stiffness with left ventricular ejection performance and right ventricular systolic pressure in mitral regurgitation before and after surgery: Wave intensity analysis. IJC HEART & VASCULATURE 2017; 16:7-13. [PMID: 29067354 PMCID: PMC5607382 DOI: 10.1016/j.ijcha.2017.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 01/09/2023]
Abstract
Background The effect of increased arterial stiffness on mitral regurgitation (MR) is not clear. Using wave intensity (WI) analysis, which is useful for analyzing ventriculo-arterial interaction, we aimed to elucidate associations of increased arterial stiffness with left ventricular (LV) ejection performance and right ventricular systolic pressure (RVSP) in MR. Methods and Results We noninvasively measured carotid arterial WI and stiffness parameter (β) in 98 patients with non-ischemic chronic MR before and after surgery, and 98 age-and-gender matched healthy subjects by ultrasonography. WI is defined as WI = (dP/dt)(dU/dt) [P: blood pressure, U: velocity, t: time]. The peak value of WI (W1) increases with LV peak dP/dt. The temporal WI index (Q-W1)st, which is the standardized interval between the Q wave of the ECG and W1, is a surrogate for preejection period. Ejection fraction (EF), left atrial volume index (LAVI), effective regurgitant orifice area (ERO), RVSP, and other echocardiographic data were also obtained. W1 was enhanced in the MR group before surgery compared with the normal group (10.7 ± 5.7 vs 8.5 ± 3.6 × 103 mmHg m/s3, p < 0.05). However, the results of two-way ANOVA showed this enhancement of W1 was observed only in the subgroup of MR before surgery with lower arterial stiffness (β < 13, p< 0.0001). ERO, β and LAVI were predictor variables before surgery to determine RVSP. EF and (Q-W1)st before surgery were predictor variables for EF after surgery. Conclusions In the MR group before surgery, increased arterial stiffness suppresses compensatory enhancement of W1, and increases RVSP. Prolonged (Q-W1)st has the potential for predicting low EF after surgery.
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Affiliation(s)
- Kiyomi Niki
- Department of Medical Engineering, Tokyo City University, 1-28-1 Tamazutsumi, Setagaya, Tokyo, Japan
| | - Motoaki Sugawara
- Department of Medical Engineering, Himeji Dokkyo University, 7-2-1 Kamiohno, Himeji, Japan
| | - Hiroshi Kayanuma
- Graduate School of Engineering, Tokyo City University, 1-28-1 Tamazutsumi, Setagaya, Tokyo, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, Japan
| | - Keitaro Mahara
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
| | - Tetsuya Sumiyoshi
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
| | - Takao Ida
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
| | - Hitonobu Tomoike
- Department of Cardiology, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu, Tokyo, Japan
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Jansen R, Kluin J, Ray SG, Cramer MJM, Suyker WJL, Chamuleau SAJ. Identification of the Asymptomatic Patient With Severe Mitral Regurgitation. Cardiol Rev 2017; 25:110-116. [DOI: 10.1097/crd.0000000000000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.5812/rijm.41456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Di Gioia G, Mega S, Nenna A, Campanale CM, Colaiori I, Scordino D, Ragni L, Miglionico M, Di Sciascio G. Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery? Int J Cardiol 2016; 227:106-113. [PMID: 27855288 DOI: 10.1016/j.ijcard.2016.11.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/24/2016] [Accepted: 11/05/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Severe primary mitral regurgitation (MR) carries a significant incidence of mortality and morbidity. Though a number of prognostic factors have been identified, the best timing for mitral valve repair is still debated. We assessed the role of Left Atrial Volume Indexed (LAVI) as predictor of adverse events after mitral valve surgery. METHODS 134 patients with severe MR were studied with a follow-up of 42±16months. Endpoints were Post-Operative Atrial Fibrillation (POAF), atrial and ventricular remodeling (LARR/LVRR) and correlation with outcome. POAF was defined as AF occurring within 2weeks and late AF (LAF) more than 2weeks after surgery. LARR was defined as LAVI reduction ≥15% and LVRR as any reduction of ventricular mass after surgery. RESULTS Forty-one patients experienced POAF, 26 had LAF. Pre-operative LAVI was an independent risk factor for POAF (OR 1.03, CI [1.00-1.06], p=0.01), LAF (OR 1.03, CI [1.00-1.06], p=0.02), LARR and LVRR (OR 1.04, CI [1.01-1.07], p=0.002, respectively). LARR was found in 75 patients, while LVRR in 111. Patients with heart remodeling had less incidence of LAF and cardiac adverse events, better diastolic function and improved their NYHA class after surgery. CONCLUSIONS LAVI should be given more weight into decision making for patients with MR as it predicts POAF and LAF and reverse atrial and ventricular remodeling, both associated to long-term outcome.
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Affiliation(s)
- Giuseppe Di Gioia
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
| | - Simona Mega
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Antonio Nenna
- Department of Medicine and Surgery, Unit of Cardiac Surgery, Campus Bio-Medico University of Rome, Italy
| | - Cosimo Marco Campanale
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Iginio Colaiori
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Domenico Scordino
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Laura Ragni
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Marco Miglionico
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
| | - Germano Di Sciascio
- Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy
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Esmaeilzadeh M, Alimi H, Hosseini S, Samiei N, Parsaee M. Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.17795/rijm41456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Impact of left ventricular ejection function on blood pressure-lowering therapy in hypertensive patients with coronary artery disease. J Hypertens 2016; 34:1011-8. [DOI: 10.1097/hjh.0000000000000874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cho EJ, Park SJ, Yun HR, Jeong DS, Lee SC, Park SW, Park PW. Predicting Left Ventricular Dysfunction after Surgery in Patients with Chronic Mitral Regurgitation: Assessment of Myocardial Deformation by 2-Dimensional Multilayer Speckle Tracking Echocardiography. Korean Circ J 2016; 46:213-21. [PMID: 27014352 PMCID: PMC4805566 DOI: 10.4070/kcj.2016.46.2.213] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 07/11/2015] [Accepted: 07/21/2015] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives The development of postoperative left ventricular (LV) dysfunction is a frequent complication in patients with chronic severe mitral valve regurgitation (MR) and portends a poor prognosis. Assessment of myocardial deformation enables myocardial contractility to be accurately estimated. The aim of the present study was to evaluate the predictive value of preoperative regional LV contractile function assessment using two-dimensional multilayer speckle-tracking echocardiography (2D MSTE) analysis in patients with chronic severe MR with preserved LV systolic function. Subjects and Methods Forty-three consecutive patients with chronic severe MR with preserved LV systolic function scheduled for mitral valve replacement (MVR) or MV repair were prospectively enrolled. Serial echocardiographic studies were performed before surgery, at 7 days follow-up, and at least 3 months follow-up postoperatively. The conventional echocardiographic parameters were analyzed. Global longitudinal strain (GLS) was obtained quantitatively by 2D MSTE. Results The mean age of patients was 51.7±14.3 years and 25 (58.1%) were male. In receiver-operating characteristic curve analysis, the most useful cutoff value for discriminating postoperative LV remodeling in severe MR with normal LV systolic function was -20.5% of 2D mid-layer GLS. Patients were divided into two groups by the baseline GLS -20.5%. Preoperative GLS values strongly predicted postoperative LV remodeling or LV dysfunction. The postoperative degree of decrease in LV end-diastolic dimension might be an additive predictive factor. Conclusion STE can be used to predict a decrease in LV function after MVR in patients with chronic severe MR. This promising method could be of use in the clinic when trying to decide upon the optimum time to schedule surgery for such patients.
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Affiliation(s)
- Eun Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Cardiology Clinic, National Cancer Center, Goyang, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hye Rim Yun
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Pyo Won Park
- Department of Thorax Surgery, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Hirota M, Yoshida M, Hoshino J, Kondo T, Isomura T. Preoperative transaortic forward flow: Prediction of surgical outcomes in patients with DCM and mitral regurgitation. Asian Cardiovasc Thorac Ann 2015; 23:781-6. [PMID: 26084956 DOI: 10.1177/0218492315583764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with dilated cardiomyopathy and mitral regurgitation, preoperative prognostic factors are very important. METHODS We hypothesized that preoperative transaortic forward flow might be related to postoperative survival, despite mitral regurgitant volume. We retrospectively evaluated surgical outcomes and echocardiographic parameters, including forward flow through the aortic valve. RESULTS Seventy-nine patients (54 males, 25 females; mean age 59 ± 12 years) with dilated cardiomyopathy and mitral regurgitation were divided into two groups according to postoperative outcome: 19 patients in group A suffered cardiac death, 60 in group B survived or died of another cause. In group A, death occurred after 227 ± 116 days, group B patients survived (except one who died of infection) for 505 ± 446 days; p < 0.01. Preoperatively, there was no significant difference in ejection fraction, end-diastolic and end-systolic volume index, mitral regurgitant volume, effective regurgitant orifice area, or right ventricular systolic pressure. Preoperative transaortic forward flow was significantly lower in group A vs. group B (1.57 ± 0.33 vs. 1.81 ± 0.46 L m(-2); p 0.04). In group B, transaortic forward flow was increased significantly before discharge (1.81 ± 0.51 vs. 2.43 ± 0.62 L m(-2); p < 0.01). Ejection fraction was significantly alleviated before discharge (28% ± 9% vs. 23% ± 8%; p < 0.01) and recovered to the preoperative value without repeat dilation of the left ventricle in late follow-up. CONCLUSIONS Preoperative transaortic forward flow may be a predictor of survival in patients with dilated cardiomyopathy and mitral regurgitation, irrespective of mitral regurgitant volume.
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Affiliation(s)
- Masanori Hirota
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
| | - Minoru Yoshida
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
| | - Joji Hoshino
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
| | - Taichi Kondo
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
| | - Tadashi Isomura
- Department of Cardiovascular Surgery, Hayama Heart Center, Kanagawa, Japan
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Zhang YM, Lu Y, Tang Y, Yang D, Wu HF, Bian ZP, Xu JD, Gu CR, Wang LS, Chen XJ. The effects of different initiation time of exercise training on left ventricular remodeling and cardiopulmonary rehabilitation in patients with left ventricular dysfunction after myocardial infarction. Disabil Rehabil 2015; 38:268-76. [PMID: 25885667 DOI: 10.3109/09638288.2015.1036174] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE The purpose of this study was to determine whether different initiation of exercise training (ET) produces different effect sizes for left ventricular (LV) remodeling and cardiopulmonary rehabilitation in patients with LV dysfunction after myocardial infarction (MI). METHOD Trials evaluating ET outcomes identified by searches in OVID MEDLINE, EMBASE, PubMed and WEB OF SCIENCE were used. Meta-analysis was conducted with the use of the software STATA 11.0. The results were expressed as the standardized mean difference (SMD), with corresponding 95% CI and p value. RESULTS The largest changes in LV remodeling and cardiopulmonary capacity rehabilitation were obtained when programs began the acute phase after MI. With the healing of MI, the beneficial effects of ET on LV ejection fraction (LVEF), LV end-systolic diameter (LVDs) and peak VO2 were gradually weakened even worse. The incidence of major adverse cardiac events was not significantly increased in acute phase post-MI. Sensitivity analyses show that ET still had significant effect in reducing LVDs and increasing peak VO2, while ET no longer had statistical effect in increasing LVEF but showed favorable trends when the same research institution's works were excluded. CONCLUSIONS ET has favorable effects on LV remodeling and cardiopulmonary rehabilitation in LV dysfunction post-MI patients. The greatest benefits are obtained when ET starts at the acute phase following MI. IMPLICATIONS FOR REHABILITATION Early exercise training is safe and feasible in acute and healing phase after myocardial infarction. Early exercise training could attenuate LV remodeling and improve cardiopulmonary capacity in patients with myocardial infarction after hospital discharge (around one week post-MI). Exercise training has favorable effects on LV remodeling and cardiopulmonary capacity rehabilitation. Exercise training should be treated to have the same roles with drugs in secondary prevention of myocardial infarction.
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Affiliation(s)
- You-Ming Zhang
- a Department of Cardiology and.,b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | - Yao Lu
- a Department of Cardiology and.,b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | - Yun Tang
- c Department of Neonatology , Huai'an First People's Hospital, Nanjing Medical University , Huai'an , Jiangsu , China
| | - Di Yang
- a Department of Cardiology and
| | | | - Zhi-Ping Bian
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | | | - Chun-Rong Gu
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
| | | | - Xiang-Jian Chen
- b Research Institute of Cardiovascular Disease, First Affiliated Hospital of Nanjing Medical University , Nanjing , China , and
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Naji P, Asfahan F, Barr T, Rodriguez LL, Grimm RA, Agarwal S, Thomas JD, Gillinov AM, Mihaljevic T, Griffin BP, Desai MY. Impact of duration of mitral regurgitation on outcomes in asymptomatic patients with myxomatous mitral valve undergoing exercise stress echocardiography. J Am Heart Assoc 2015; 4:jah3819. [PMID: 25672368 PMCID: PMC4345867 DOI: 10.1161/jaha.114.001348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Significant mitral regurgitation (MR) typically occurs as holosystolic (HS) or mid‐late systolic (MLS), with differences in volumetric impact on the left ventricle (LV). We sought to assess outcomes of degenerative MR patients undergoing exercise echocardiography, separated based on MR duration (MLS versus HS). Methods and Results We included 609 consecutive patients with ≥III+myxomatous MR undergoing exercise echocardiography: HS (n=487) and MLS (n=122). MLS MR was defined as delayed appearance of MR signal during mid‐late systole on continuous‐wave Doppler while HS MR occurred throughout systole. Composite events of death and congestive heart failure were recorded. Compared to MLS MR, HS MR patients were older (60±14 versus 53±14 years), more were males (72% versus 53%), and had greater prevalence of atrial fibrillation (16% versus 7%; all P<0.01). HS MR patients had higher right ventricular systolic pressure (RVSP) at rest (33±11 versus 27±9 mm Hg), more flail leaflets (36% versus 6%), and a lower number of metabolic equivalents (METs) achieved (9.5±3 versus 10.5±3), compared to the MLS MR group (all P<0.05). There were 54 events during 7.1±3 years of follow‐up. On step‐wise multivariable analysis, HS versus MLS MR (HR 4.99 [1.21 to 20.14]), higher LV ejection fraction (hazard ratio [HR], 0.94 [0.89 to 0.98]), atrial fibrillation (HR, 2.59 [1.33 to 5.11]), higher RVSP (HR, 1.05 [1.03 to 1.09]), and higher percentage of age‐ and gender‐predicted METs (HR, 0.98 [0.97 to 0.99]) were independently associated with adverse outcomes (all P<0.05). Conclusion In patients with ≥III+myxomatous MR undergoing exercise echocardiography, holosystolic MR is associated with adverse outcomes, independent of other predictors.
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Affiliation(s)
- Peyman Naji
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Fadi Asfahan
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Tyler Barr
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - L Leonardo Rodriguez
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Richard A Grimm
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Shikhar Agarwal
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - James D Thomas
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - A Marc Gillinov
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Tomislav Mihaljevic
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH (P.N., F.A., T.B., L.R., R.A.G., S.A., J.D.T., M.G., T.M., B.P.G., M.Y.D.)
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LV Mechanics in Mitral and Aortic Valve Diseases. JACC Cardiovasc Imaging 2014; 7:1151-66. [DOI: 10.1016/j.jcmg.2014.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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Predicting early left ventricular dysfunction after mitral valve reconstruction: The effect of atrial fibrillation and pulmonary hypertension. J Thorac Cardiovasc Surg 2014; 148:422-7. [DOI: 10.1016/j.jtcvs.2013.08.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/02/2013] [Accepted: 08/22/2013] [Indexed: 11/24/2022]
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Incremental Value of Three-Dimensional Echocardiography in the Evaluation of Left Ventricular Size in Mitral Regurgitation: A Follow-Up Study after Mitral Valve Surgery. J Am Soc Echocardiogr 2014; 27:608-15. [DOI: 10.1016/j.echo.2014.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Indexed: 12/30/2022]
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Biscione C, Forleo GB, Costantino MF, Sergnese O, Aluigi S, Sergi D, Mariano E, Dores E, Di Luozzo M, Romeo F. Preoperative echocardiographic measures as predictors of left ventricular dysfunction after mitral valve repair. Int J Cardiol 2014; 171:e35-6. [PMID: 24373630 DOI: 10.1016/j.ijcard.2013.11.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/30/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Carmine Biscione
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | | | | | - Oriana Sergnese
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy.
| | - Simona Aluigi
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | - Domenico Sergi
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | - Enrica Mariano
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | - Ernesta Dores
- Heart Department, San Carlo Hospital, Potenza, Italy
| | - Marco Di Luozzo
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
| | - Francesco Romeo
- Department of Cardiology, University of Rome "Tor Vergata", Rome, Italy
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Sugiura J, Nakano T, Oda S, Usui A, Ueda Y, Kado H. Effects of tricuspid valve surgery on tricuspid regurgitation in patients with hypoplastic left heart syndrome: a non-randomized series comparing surgical and non-surgical cases. Eur J Cardiothorac Surg 2014; 46:8-13. [DOI: 10.1093/ejcts/ezt613] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sénéchal M, MacHaalany J, Bertrand OF, O'Connor K, Parenteau J, Dubois-Sénéchal IN, Costerousse O, Dubois M, Voisine P. Predictors of left ventricular remodeling after surgical repair or replacement for pure severe mitral regurgitation caused by leaflet prolapse. Am J Cardiol 2013; 112:567-73. [PMID: 23683949 DOI: 10.1016/j.amjcard.2013.04.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/04/2013] [Accepted: 04/04/2013] [Indexed: 11/24/2022]
Abstract
We sought to determine whether preoperative baseline echocardiographic analysis and the type of surgical procedure are predictive of the magnitude and timing of postoperative left ventricular (LV) remodeling in patients undergoing valve surgery for pure severe mitral regurgitation (MR) secondary to leaflet prolapse. Seventy-two consecutive patients without coronary artery disease undergoing valve repair (MVr; n = 42) or replacement (MVR; n = 30) underwent preoperative, early (1 to 2 days) and late postoperative (4.5 ± 2.5 and 18 ± 8.0 months) echocardiography. Patients were categorized according to their baseline LV ejection fraction (EF) (Group 1: EF ≥60%, Group 2: EF = 50% to 59%, Group 3: EF <50%). Preservation of the subvalvular apparatus was achieved in most patients undergoing MV replacement (87%). Over a median follow-up period of 450 days, LVEF changed as follows: Group 1: 63% ± 2% to 60% ± 3% (p <0.0001); Group 2: 55% ± 3% to 52% ± 6% (p <0.0001); Group 3: 43% ± 4% to 42% ± 5% (p <0.01). Two-thirds of the observed changes in LV diameters and volumes occurred in the first 6 months. Preoperative LVEF was the best predictor of postoperative LVEF ≥60% (odds ratio 1.50, 95% confidence interval, 1.25 to 1.97; p <0.0001). No significant difference was found in LV remodeling parameters between patients undergoing MVr and MVR. In conclusion, patients with pure severe MR due to valve prolapse LVEF remained normal after surgery only in patients with baseline LVEF ≥60%. MVR with subvalvular preservation was associated with similar postoperative remodeling as MVr.
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Le Tourneau T, Deswarte G, Lamblin N, Foucher-Hossein C, Fayad G, Richardson M, Polge AS, Vannesson C, Topilsky Y, Juthier F, Trochu JN, Enriquez-Sarano M, Bauters C. Right ventricular systolic function in organic mitral regurgitation: impact of biventricular impairment. Circulation 2013; 127:1597-608. [PMID: 23487435 DOI: 10.1161/circulationaha.112.000999] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To assess the prevalence, determinants, and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation. METHODS AND RESULTS Two hundred eight patients (62±12 years, 138 males) with chronic organic mitral regurgitation referred to surgery underwent an echocardiography and biventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10% to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (left ventricular EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were left ventricular septal function (β=0.42, P<0.0001), left ventricular end-diastolic diameter index (β=-0.22, P=0.002), and pulmonary artery systolic pressure (β=-0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β=-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3-37.9±7.3, P<0.0001) in patients with depressed RV EF, whereas it did not change in others (P=0.91). RV EF ≤35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±15.3% versus 90.3±3.2%, P<0.0001; hazard ratio, 5.2; P<0.0001) even after adjustment for known predictors (hazard ratio, 4.6; P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P=0.003; hazard ratio, 2.5; P=0.005) even after adjustment for known predictors (P=0.048). CONCLUSIONS In patients with organic mitral regurgitation referred to surgery, RV function impairment is frequent (30%) and depends weakly on pulmonary artery systolic pressure but mainly on left ventricular remodeling and septal function. RV function is a predictor of postoperative cardiovascular survival, whereas biventricular impairment is a powerful predictor of both cardiovascular and overall survival.
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Dolor-Torres MC, Ling LH. Surgical timing of degenerative mitral regurgitation: what to consider. J Cardiovasc Ultrasound 2012; 20:165-71. [PMID: 23346284 PMCID: PMC3542508 DOI: 10.4250/jcu.2012.20.4.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/09/2012] [Accepted: 11/21/2012] [Indexed: 01/19/2023] Open
Abstract
Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
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Comparison of need for operative therapy in patients with mitral valve prolapse involving both leaflets versus posterior leaflet only. Am J Cardiol 2012; 110:1350-3. [PMID: 22835412 DOI: 10.1016/j.amjcard.2012.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 11/20/2022]
Abstract
Mitral valve prolapse may involve 1 leaflet or 2 leaflets, yet management guidelines do not differentiate posterior leaflet (PML) from bileaflet (BML) prolapse. We hypothesized that patients with BML have a prolonged natural history with more severe atrial and ventricular enlargement but less severe mitral regurgitation (MR) compared to patients with PML. Patients with mitral valve prolapse undergoing mitral repair were identified and preoperative characteristics were recorded. Patients with predominant PML prolapse (n = 304) versus BML prolapse (n = 131) were identified based on preoperative echocardiographic and intraoperative findings. Timing of operation was based on standard guidelines. Despite being equally symptomatic, patients with BML differed significantly from those with PML in being younger (54 vs 60 years, p <0.0001), more likely to be women (51% vs 24%, p <0.0001), and having a larger valve (37 vs 32 mm, p <0.0001). Despite similar cardiac function and dimensions, patients with BML had less severe MR (24% vs 13% with <4+ MR, p = 0.01) and less severe pulmonary hypertension (14% vs 31%, p <0.0001) at time of operation. In conclusion, patients with BML often meet indications for mitral valve repair with similar cardiac enlargement but less MR than patients with PML prolapse. Patients with BML prolapse may benefit from timing mitral repair based more on symptomatic 3+ MR or cardiac enlargement and less on presence of severe MR.
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Witkowski TG, Thomas JD, Debonnaire PJMR, Delgado V, Hoke U, Ewe SH, Versteegh MIM, Holman ER, Schalij MJ, Bax JJ, Klautz RJM, Marsan NA. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging 2012; 14:69-76. [DOI: 10.1093/ehjci/jes155] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Predictive Value of Global Longitudinal Strain in a Surgical Population of Organic Mitral Regurgitation. J Am Soc Echocardiogr 2012; 25:766-72. [DOI: 10.1016/j.echo.2012.04.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Indexed: 12/28/2022]
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Donal E, Mascle S, Brunet A, Thebault C, Corbineau H, Laurent M, Leguerrier A, Mabo P. Prediction of left ventricular ejection fraction 6 months after surgical correction of organic mitral regurgitation: the value of exercise echocardiography and deformation imaging. Eur Heart J Cardiovasc Imaging 2012; 13:922-30. [DOI: 10.1093/ehjci/jes068] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schiros CG, Dell'Italia LJ, Gladden JD, Clark D, Aban I, Gupta H, Lloyd SG, McGiffin DC, Perry G, Denney TS, Ahmed MI. Magnetic resonance imaging with 3-dimensional analysis of left ventricular remodeling in isolated mitral regurgitation: implications beyond dimensions. Circulation 2012; 125:2334-42. [PMID: 22496130 DOI: 10.1161/circulationaha.111.073239] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although surgery is indicated in patients with mitral regurgitation (MR) when left ventricular (LV) end-systolic (LVES) dimension is >40 mm, LV ejection fraction may decrease after mitral valve surgery. We hypothesize that significant LV remodeling before surgery is not reflected by standard echocardiographic parameters measured at the base of the heart. METHODS AND RESULTS Ninety-four patients (age, 54 ± 11 years; 38% female) with degenerative isolated MR underwent cine magnetic resonance imaging with tissue tagging and 3-dimensional analysis. In 51 control subjects (age, 44 ± 14 years; 53% female), the relation between LVES volume (LVESV) and LVES dimension was quadratic, whereas in 94 MR patients, this relation was cubic, indicating a greater increase in LVESV per LVES dimension among MR patients. Moreover, magnetic resonance imaging LVESV from summated serial short-axis slices was significantly greater than LVESV assessed with the Bullet formula in MR patients, attributed to a more spherical remodeling distal to the tips of the papillary muscles (P<0.001). Thirty-five patients underwent mitral valve repair per current guideline recommendations. LV ejection fraction decreased from 61 ± 7% to 54 ± 8% (P<0.0001) and maximum shortening decreased significantly below normal at 1 year postoperatively (P<0.0001). Despite normalization of LV stroke volume and LV end-diastolic volume/mass ratio, there was a persistent significant increase in distal LVES 3-dimensional radius/wall thickness ratio and LVESV index after surgery. CONCLUSIONS Despite apparently preserved LVES dimension, MR patients demonstrate significant spherical mid to apical LVES remodeling that contributes to higher LVESV than predicted by standard geometry-based calculations. Decreased LV strain after surgery suggests that a volumetric analysis of LV remodeling and function may be preferred to evaluate disease progression in isolated MR.
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Affiliation(s)
- Chun G Schiros
- Samuel Ginn College of Engineering, Department of Electrical and Computer Engineering, Auburn University, Auburn, AL, USA
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Changes in Left Ventricular Function After Mitral Valve Repair for Severe Organic Mitral Regurgitation. Ann Thorac Surg 2012; 93:754-60. [DOI: 10.1016/j.athoracsur.2011.11.034] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 11/09/2011] [Accepted: 11/14/2011] [Indexed: 11/22/2022]
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Yurdakul S, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Aytekin S. Subclinical Left Ventricular Dysfunction in Asymptomatic Chronic Mitral Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging-Based Study. Echocardiography 2011; 28:877-85. [DOI: 10.1111/j.1540-8175.2011.01428.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Tribouilloy C, Rusinaru D, Szymanski C, Mezghani S, Fournier A, Levy F, Peltier M, Ben Ammar A, Carmi D, Remadi JP, Caus T, Touati G. Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:702-10. [DOI: 10.1093/ejechocard/jer128] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Song JM, Kang SH, Lee EJ, Shin MJ, Lee JW, Chung CH, Kim DH, Kang DH, Song JK. Echocardiographic Predictors of Left Ventricular Function and Clinical Outcomes After Successful Mitral Valve Repair: Conventional Two-Dimensional Versus Speckle-Tracking Parameters. Ann Thorac Surg 2011; 91:1816-23. [DOI: 10.1016/j.athoracsur.2011.02.055] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 10/18/2022]
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