1
|
Fukuda S, Song JK, Mahara K, Kuwaki H, Jang JY, Takeuchi M, Sun BJ, Kim YJ, Miyamoto T, Oginosawa Y, Sonoda S, Eto M, Nishimura Y, Takanashi S, Levine RA, Otsuji Y. Basal Left Ventricular Dilatation and Reduced Contraction in Patients With Mitral Valve Prolapse Can Be Secondary to Annular Dilatation. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.005113. [DOI: 10.1161/circimaging.115.005113] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
Background—
Prominent mitral valve (MV) annular dilatation with only modest left ventricular (LV) dilatation in patients with MV prolapse (MVP) suggests predominant dilatation in adjacent basal LV, which may augment regional wall tension and attenuate contraction by Laplace’s law. We hypothesized that MV annular dilatation in patients with MVP is associated with the basal predominance of LV dilatation and attenuated contraction, which can be altered by surgical MV plasty with annulus reduction.
Methods and Results—
Echocardiography with speckle-tracking analysis to assess regional cross-sectional short-axis area and longitudinal contraction (strain) of basal, middle, and apical LV was performed in 30 controls and 130 patients with MVP. The basal value/averaged middle and apical values (B/M·A ratio) of LV cross-sectional area and strain were obtained. Patients with MVP showed significantly greater MV annular area (6.4±1.6 versus 3.7±0.6 cm
2
/m
2
), increased B/M·A LV area ratio (2.4±0.5 versus 1.8±0.2), and reduced B/M·A LV strain ratio (0.83±0.14 versus 0.96±0.09) than controls (
P
<0.001). Multivariable analyses identified that MV annular dilatation was independently associated with increased B/M·A LV area ratio (β=0.60,
P
<0.001), which was associated with reduced B/M·A LV strain ratio (β=−0.32,
P
<0.001). In 35 patients with MVP, B/M·A LV area and strain ratio significantly altered after surgical MV plasty with annulus reduction (2.5±0.5–1.8±0.3 and 0.73±0.10–0.89±0.17,
P
<0.001, respectively).
Conclusions—
In patients with MVP, MV annular dilatation was associated with the basal predominance of LV dilatation and reduced contraction, which can be altered by surgical MV plasty with annulus reduction, suggesting unfavorable influence from MV annular dilatation on basal LV.
Collapse
Affiliation(s)
- Shota Fukuda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jae-Kwan Song
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Keitaro Mahara
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Hiroshi Kuwaki
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Jeong Yoon Jang
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masaaki Takeuchi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Byung Joo Sun
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yun Jeong Kim
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Tetsu Miyamoto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yasushi Oginosawa
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shinjo Sonoda
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Masataka Eto
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yosuke Nishimura
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Shuichiro Takanashi
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Robert A. Levine
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| | - Yutaka Otsuji
- From the Second Department of Internal Medicine (S.F., H.K., T.M., Y.O., S.S., Y.O.), Departments of Laboratory and Transfusion Medicine (M.T.), and Cardiovascular Surgery (M.E., Y.N.), University of Occupational and Environmental Health, Kitakyushu, Japan; Cardiac Imaging Center, Asan Medical Center Heart Institute, Seoul, South Korea (J.-K.S., J.Y.J., B.J.S., J.K.); Departments of Cardiology (K.M., S.T.) and Cardiovascular Surgery (K.M., S.T.), Sakakibara Heart Institute, Fuchu, Japan; and Cardiac
| |
Collapse
|
2
|
Pong T, Scherrer-Crosbie M, Atochin DN, Bloch KD, Huang PL. Phosphomimetic modulation of eNOS improves myocardial reperfusion and mimics cardiac postconditioning in mice. PLoS One 2014; 9:e85946. [PMID: 24465805 PMCID: PMC3897570 DOI: 10.1371/journal.pone.0085946] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/04/2013] [Indexed: 12/16/2022] Open
Abstract
Objective Myocardial infarction resulting from ischemia-reperfusion injury can be reduced by cardiac postconditioning, in which blood flow is restored intermittently prior to full reperfusion. Although key molecular mechanisms and prosurvival pathways involved in postconditioning have been identified, a direct role for eNOS-derived NO in improving regional myocardial perfusion has not been shown. The objective of this study is to measure, with high temporal and spatial resolution, regional myocardial perfusion during ischemia-reperfusion and postconditioning, in order to determine the contribution of regional blood flow effects of NO to infarct size and protection. Methods and Results We used myocardial contrast echocardiography to measure regional myocardial blood flow in mice over time. Reperfusion after myocardial ischemia-reperfusion injury is improved by postconditioning, as well as by phosphomimetic eNOS modulation. Knock-in mice expressing a phosphomimetic S1176D form of eNOS showed improved myocardial reperfusion and significantly reduced infarct size. eNOS knock-out mice failed to show cardioprotection from postconditioning. The size of the no-reflow zone following ischemia-reperfusion is substantially reduced by postconditioning and by the phosphomimetic eNOS mutation. Conclusions and Significance Using myocardial contrast echocardiography, we show that temporal dynamics of regional myocardial perfusion restoration contribute to reduced infarct size after postconditioning. eNOS has direct effects on myocardial blood flow following ischemia-reperfusion, with reduction in the size of the no-reflow zone. These results have important implications for ongoing clinical trials on cardioprotection, because the degree of protective benefit may be significantly influenced by the regional hemodynamic effects of eNOS-derived NO.
Collapse
Affiliation(s)
- Terrence Pong
- Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, United States of America
| | - Marielle Scherrer-Crosbie
- Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Cardiac Ultrasound Laboratory, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Dmitriy N. Atochin
- Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Kenneth D. Bloch
- Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Anesthesia Center for Critical Care Research, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Paul L. Huang
- Cardiovascular Research Center, Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts, United States of America
- Harvard-MIT Division of Health Sciences & Technology, Cambridge, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|