Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction

Abstract

The indication for surgery in asymptomatic severe mitral regurgitation (SMR) with preserved left ventricular ejection fraction (LVEF) is controversial. We sought to study 3D myocardial mechanics in this population and test 3D-speckle tracking (3DST) parameters as possible predictors of events. 45 asymptomatic patients with SMR and LVEF >60 % and 20 control individuals without cardiac disease underwent 3DST echocardiography. MR group additionally underwent further clinical monitoring. Dyspnea, LVEF under 60 %, or admissions for heart failure were considered as events. When compared with control group, MR group showed lower percentage of global 3D strain, (35.4 ± 9.1 vs. 43.9 ± 10.6; p = 0.003), lower radial strain, lower area change rate and higher end-diastolic volume. In a follow-up time of 23.2 ± 14.5 months we found 15 events (33.3 %). When comparing the remaining patients with this new-onset HF group we found significant differences in longitudinal strain (-17.9 ± 3.3 vs. -15.8 ± 2.1; p = 0.036), area strain (AS) (-48.6 ± 4.6 vs. -43.7 ± 6.2; p = 0.006), circumferential strain (-35.8 ± 4.7 vs. -31.8 ± 6.1; p = 0.034), 3D LVEF (67.1 ± 4.6 vs. 63.0 ± 7.4; p = 0.034) and E/E' index (13.5 ± 3.9 vs. 19.3 ± 9.5; p = 0.006). In multivariate Cox regression AS alone was the only independent predictor. A cutoff value of AS greater than -41.6 % reached a hazard ratio of 4.41 (p = 0.004) for prediction of events. In asymptomatic patients with SMR and preserved ejection fraction, 3DST derived AS is a promising tool for predicting the development of heart failure. This finding may be useful for guiding the selection of patients for early mitral valve repair/replacement surgery even if they are asymptomatic.

Impact of area strain by 3D speckle tracking on clinical outcome in patients after acute myocardial infarction

“…Also relatively low temporal and spatial resolution can affect optimal tracking and accurate data acquisition, whereas prior data have shown that myocardial deformation measurements were not compromised by 3D speckle tracking when derived from 18~25 frames/s datasets . While several studies have shown the utility of 3D speckle tracking in various clinical scenarios, clinical implication of 3D speckle tracking is currently being increasingly explored . However, there are limited data regarding the clinical prognostic value of 3D speckle tracking in the patients with acute MI.…”

“…have shown the utility of 3D speckle tracking in various clinical scenarios, clinical implication of 3D speckle tracking is currently being increasingly explored [18][19][20][21][22][23][24]. However, there are limited data regarding the clinical prognostic value of 3D speckle tracking in the patients with acute MI.…”

Three-dimensional speckle-tracking echocardiography: benefits and limitations of integrating myocardial mechanics with three-dimensional imaging

“…In severe chronic mitral regurgitation (MR), guidelines recommend intervening on symptomatic patients or when LVEF drops (59,60). However, in patients with severe MR and LVEF still within normal range, subclinical LV dysfunction may go unrecognized (61,62). It was demonstrated that 2DSTE-derived LV global longitudinal strain may be useful to identify a maladaptive preloadrelated change associated with the risk for a substantial reduction in LVEF immediately following mitral valve repair (6,63,64).…”

“…It was demonstrated that 2DSTE-derived LV global longitudinal strain may be useful to identify a maladaptive preloadrelated change associated with the risk for a substantial reduction in LVEF immediately following mitral valve repair (6,63,64). At present, few studies (62,65,66) have looked at the role of 3DSTE in patients with MR. In patients with MR with preserved LVEF, 3D area strain was shown to be an independent predictor of early symptoms or LV dysfunction (62).…”

Deformation imaging to assess global and regional effects of cardiac regenerative therapy in ischaemic heart disease: A systematic review

“…Deformation imaging has already proven its value in, for example, hypertrophic cardiomyopathy (Fuster, Van Der Zee, & Miller, 2009) and valvular heart disease (Casas-Rojo et al, 2016;Gunjan, Kurien, & Tyagi, 2012), in which deterioration of deformation parameters can be observed before LVEF decreases. This apparent superior sensitivity for changes in cardiac function makes deformation imaging of great potential use within cardiac regenerative medicine.…”