Dobutamine-Induced Improvement in Inferior Myocardial Contractile Function Predicts Reduction in Functional Mitral Regurgitation

Tatsumi, Kazuhiro; Kawai, Hiroya; Sugiyama, Daisuke; Norisada, Kazuko; Kataoka, Toshiya; Onishi, Tetsuari; Tanaka, Hidekazu; Hirata, Ken Ichi

doi:10.1161/circimaging.110.937300

Cited by 16 publications

(8 citation statements)

References 34 publications

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“…38 The ability to better quantify regional function has also provided insight into the mechanisms underlying disease processes, such as ischemic mitral regurgitation. 39 The ability of strain imaging to quantify the regional timing of deformation has led to its widespread application in the assessment of ventricular synchrony. Quantifying the temporal dispersion in contractility has provided important insights into the load dependency of ventricular dyssynchrony, 40 the linkage between dyssynchrony and impaired contractile function, 41 and the prognostic relevance of dyssynchrony in select groups of patients with QRS duration Ͻ120 ms. 42 These measures have also been used to assess the relationship between dyssynchrony measures and response after resynchronization therapy.…”

Section: Quantification Of Regional Functionmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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M yocardial deformation imaging is a novel echocardiographic method for assessment of global and regional myocardial function. As this technology has evolved, it has been applied to an increasing number of research questions, and the number of publications incorporating deformation imaging has grown in parallel.Although not yet sufficiently vetted for routine clinical use, these methods offer the long-term potential for more complete, accurate, and reproducible assessment of myocardial function. What Is Myocardial Deformation Imaging?Evaluation of contractile function with echocardiography has traditionally been limited to volume-based assessment of ejection fraction (EF) and assessment of regional wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function.During systole, the ventricular myocardium simultaneously shortens in the longitudinal and circumferential planes and thickens in the radial plane, with reciprocal changes in diastole ( Figure). Deformation imaging, in the broadest sense, allows for more direct assessment of myocardial muscle shortening and lengthening throughout the cardiac cycle by assessing regional myocardial strain and strain rate. Strain is defined as the change in length of a segment of myocardium relative to its resting length and is expressed as a percentage; strain rate is the rate of this deformation. Longitudinal and circumferential shortening results in negative strain values, whereas radial thickening results in a positive strain value. Previously, assessment of myocardial strain could be performed with the use of sonomicrometry crystals, which can only be performed experimentally 1 or with magnetic resonance imaging-based myocardial tagging, 2,3 which is limited by relatively low temporal resolution and the limited availability and expense of cardiac magnetic resonance imaging. Extension of these techniques to echocardiography has allowed for substantially greater utility in a broader range of patients.Myocardial deformation imaging with echocardiography can be performed with the use of either tissue Doppler-based or 2-dimensional speckle tracking-based methods. Doppler methods, developed initially, utilize the velocity gradient present along the length of the left ventricle (LV) to calculate strain rate, which is then integrated to derive strain. This technique suffers from limitations similar to those of traditional Doppler because it can only accurately assess deformation in the plane incident with the ultrasound beam and requires prospective acquisition of dedicated images at high frame rate. B-mode speckle tracking, sometimes referred to as feature tracking, utilizes the movement of the coherent ultrasound backscatter speckle pattern within B-mode echocardiographic images to assess myocardial...

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Section: Quantification Of Regional Functionmentioning

confidence: 99%

Myocardial Deformation Imaging

2012

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“…Indeed, myocardial viability and absence of dyssynchrony were independent predictors of IMR improvement. Similarly, enhancement of inferior myocardial contractile function with dobutamine was associated with reduction of apical tenting and IMR severity in 51 patients with ischemic and non-ischemic cardiomyopathy 111 . Conversely, patients with severe IMR and advanced scarring of the posterior papillary muscle region as assessed by MRI are at higher risk for recurrent mitral insufficiency after revascularization and standard annuloplasty repair 112 .…”

Section: Novel Surgical Interventionsmentioning

confidence: 85%

Another Multidisciplinary Look at Ischemic Mitral Regurgitation

Timek

Miller

2011

Seminars in Thoracic and Cardiovascular Surgery

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“…Second, dobutamine stress to detect myocardial contractile reserve shows a tendency to improve LV systolic function and reduce LV chamber size more than exercise 17,18. This might result in more improvement in LV geometry and MV closing force 19. Even though contractile reserve in each segment was not measured, contractile function in segments attached to the papillary muscles might be especially important in terms of improvement of MV geometry.…”

Section: Discussionmentioning

confidence: 99%

Response of Functional Mitral Regurgitation during Dobutamine Infusion in Relation to Changes in Left Ventricular Dyssynchrony and Mitral Valve Geometry

Choi

Kim

et al. 2014

Yonsei Med J

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PurposeFunctional mitral regurgitation (FMR) and myocardial dyssynchrony commonly occur in patients with dilated cardiomyopathy (DCM). The aim of this study was to elucidate changes in FMR in relation to those in left ventricular (LV) dyssynchrony as well as geometric parameters of the mitral valve (MV) in DCM patients during dobutamine infusion.Materials and MethodsTwenty-nine DCM patients (M:F=15:14; age: 62±15 yrs) with FMR underwent echocardiography at baseline and during peak dose (30 or 40 ug/min) of dobutamine infusion. Using 2D echocardiography, LV end-diastolic volume, end-systolic volume (LVESV), ejection fraction (EF), and effective regurgitant orifice area (ERO) were estimated. Dyssynchrony indices (DIs), defined as the standard deviation of time interval-to-peak myocardial systolic contraction of eight LV segments, were measured. Using the multi-planar reconstructive mode from commercially available 3D image analysis software, MV tenting area (MVTa) was measured. All geometrical measurements were corrected (c) by the height of each patient.ResultsDuring dobutamine infusion, EF (28±8% vs. 39±11%, p=0.001) improved along with significant decrease in cLVESV (80.1±35.2 mm3/m vs. 60.4±31.1 mm3/m, p=0.001); cMVTa (1.28±0.48 cm2/m vs. 0.79±0.33 cm2/m, p=0.001) was significantly reduced; and DI (1.31±0.51 vs. 1.58±0.68, p=0.025) showed significant increase. Despite significant deterioration of LV dyssynchrony during dobutamine infusion, ERO (0.16±0.09 cm2 vs. 0.09±0.08 cm2, p=0.001) significantly improved. On multivariate analysis, ΔcMVTa and ΔEF were found to be the strongest independent determinants of ΔERO (R2=0.443, p=0.001).ConclusionRather than LV dyssynchrony, MV geometry determined by LV geometry and systolic pressure, which represents the MV closing force, may be the primary determinant of MR severity.

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Dobutamine-Induced Improvement in Inferior Myocardial Contractile Function Predicts Reduction in Functional Mitral Regurgitation

Abstract: Background-Left ventricular (LV) remodeling can increase tethering force to mitral valve and functional mitral regurgitation (FMR

Cited by 16 publications

References 34 publications

Myocardial Deformation Imaging

Myocardial Deformation Imaging

Another Multidisciplinary Look at Ischemic Mitral Regurgitation

Response of Functional Mitral Regurgitation during Dobutamine Infusion in Relation to Changes in Left Ventricular Dyssynchrony and Mitral Valve Geometry

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