Left Atrium Reverse Remodeling in Patients With Mitral Valve Stenosis After Percutaneous Valvuloplasty: A 2- and 3-Dimensional Echocardiographic Study

Vieira, Marcelo Luís Campos; Silva, Murilo C.; Wagner, Camila R.; Dallan, Luís Augusto Palma; Kajita, Luiz J.; Oliveira, Wercules; Samesina, Nelson; Hotta, Viviane Tiemi; Mathias, Wilson; Spina, Guilherme Sobreira; Cardoso, Luís; Pastore, Carlos Alberto; Tarasoutchi, Flávio; Grinberg, Max

doi:10.1016/j.rec.2012.05.004

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…Our results are in agreement with Vieira et al 26 who stated that the main acute impacts on the LA were a decrease in the mitral valve afterload, as reflected by an increase in the mitral valve area, a decrease in the mean and peak mitral valve gradients, a decrease in pulmonary systolic pressure, and a decrease in the LA anteroposterior diameter.…”

Section: Who Stated That Interatrial Emd Gets Longer In Mssupporting

confidence: 93%

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Saad

El-Salam

Elzaki

et al. 2016

The Egyptian Heart Journal

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Background: The predisposition to atrial fibrillation (AF) in mitral stenosis (MS) has been demonstrated with several electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (atrial electromechanical delay). After percutaneous mitral balloon valvuloplasty (PMBV), the improvement in echocardiographic parameters related to AF risk is unknown. We aimed to assess the interatrial electromechanical coupling by Tissue Doppler Imaging (TDI) echocardiography in MS before and after PBMV. Patients and methods: This study included 45 patients with moderate to severe MS who underwent successful PMBV without complication at our clinic and 20 healthy volunteers as a control group. We compared the two groups in regard to clinical, electrocardiographic and echocardiographic features. The patients with MS were also evaluated one week after PMBV. Interatrial electromechanical delay (EMD) was measured by TDI before and after PMBV and we compared the results.Abbreviations: A 0 wave, peak late annular velocity by TDI; AF, atrial fibrillation; BSA, body surface area; LA, left atrium; LAA, left atrial area; LAD, left atrial dimension; LAEF, left atrial ejection fraction; LAEI, left atrial expansion index; LAV, left atrial volume; MS, mitral stenosis; MV, mitral valve; MVA, mitral valve area; P-A 0 , the time interval from the initiation of the P wave on the ECG until the beginning of the late diastolic TDI signal at the lateral border of the annulus; PBMV, percutaneous balloon mitral valvuloplasty; P-max, maximum P-wave duration; P-min, minimum P-wave duration; PWD, P-wave dispersion; SPAP, systolic pulmonary artery pressure; TDI, Tissue Doppler Imaging Results: The interatrial EMD (56.4 ± 15.8 vs. 34.6 ± 7.2 ms, p < 0.001) was higher in patients with MS as compared to healthy individuals. The maximum P-wave duration (P-max) and Pwave dispersion (PWD) showed significant positive correlation with the interatrial EMD (r = 0.37, p < 0.05 and r = 0.41, p < 0.05 respectively). There was a highly significant decrease in the interatrial EMD (56.4 ± 15.8 vs. 38.3 ± 10.4 ms, p < 0.001) one week after PBMV. Conclusion: The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PMBV.ª 2015 Production and hosting by Elsevier B.V. on behalf of Egyptian Society of Cardiology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Section: Who Stated That Interatrial Emd Gets Longer In Mssupporting

confidence: 93%

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Saad

El-Salam

Elzaki

et al. 2016

The Egyptian Heart Journal

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“…Our results come in agreement with Vieira et al, [31] who said that following PBMV; the decline in the MV afterload and the main acute impact on the LA were expressed by an increase in the MVA, a decline in mean and peak mitral valve gradients, a decline in the LA antero-posterior diameter and a decline in SPAP.…”

Section: Disscussionsupporting

confidence: 93%

Assessment of Interatrial Dyssynchrony by Tissue Doppler Imaging in Mitral Stenosis: Effect of Afterload Reduction After Balloon Mitral Valvuloplasty.

Saad¹,

El-Salam²,

Elzaki³

et al. 2015

Zagazig University Medical Journal

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Background: Atrial fibrillation (AF) predisposition in mitral stenosis (MS) has been studied using many electrocardiographic (increased P-wave dispersion) and echocardiographic parameters (interatrial electromechanical delay). There are scarce data on the effect of percutaneous balloon mitral valvuloplasty (PBMV) on the interatrial electromechanical coupling in patients with MS. We aimed to assess the interatrial electromechanical coupling in MS before and after PBMV by tissue Doppler imaging (TDI) echocardiography. Patients and methods: This study included 45 patients suffered from moderate to severe MS who underwent PBMV successfully without complication and 20 healthy volunteers as a control group. We compared between both groups in the clinical, electrocardiographic and echocardiographic parameters. The patients with MS were re-evaluated one week after PBMV. Interatrial electromechanical delay (EMD) was estimated by TDI before and after PBMV and we compared the results. Results: The interatrial EMD (56.4  15.8 vs. 34.6  7.2 ms, p < 0.001) was higher in patients with MS as compared to healthy individuals. The maximum P-wave duration (P-max) and P-wave dispersion (PWD) showed highly significant positive correlation with the interatrial EMD (r = 0.37, p < 0.001 and r = 0.41, p < 0.001 respectively). There was a highly significant decrease in the interatrial EMD (56.4  15.8 vs. 38.3  10.4 ms, p < 0.001) one week after PBMV. Conclusion: The current study showed significant increase in the interatrial EMD in patients with moderate to severe MS. These changes improved significantly after PBMV.

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“…8 Vieira et al showed a significant reduction in LA volumes and LAEF 72 hours and 1 year after the procedure. 9 It must be stressed that the parameters used to assess the left atrial functions were different in each of these studies with no established standards used to define various components of LA function. After thorough research of the available literature we carefully selected only those parameters which are well substantiated by quality evidence as reliable measures of LA function in many diseases other than rheumatic mitral stenosis.…”

Section: Discussionmentioning

confidence: 99%

“…These changes are followed by decrease in LA volumes and increase in LAEF, which might reflect a tight relationship among pressure, volume and function. 9 The rapid recovery of LA reservoir and conduit functions following BMV suggests that these functions are predominantly dependent on LA volumes and afterload. The failure of immediate improvement in LA pump function after BMV could be attributed to the lack of acute changes in LA structure, including fibrosis of atrial wall, disorganization of atrial muscle bundles and intrinsic contractile dysfunction of atrial myocytes.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] However, there are very few studies reported in literature which have assessed the impact of BMV on left atrial mechanical functions. 8,9 The present study was conducted to evaluate the acute impact of successful BMV on phasic left atrial volumes and left atrial mechanical functions in patients with severe mitral stenosis and normal sinus rhythm.…”

Section: Introductionmentioning

confidence: 99%

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Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

Beig¹,

Dar²,

Kumar³

et al. 2017

JCDR

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Background: Rheumatic mitral stenosis (MS) is associated with progressive impairment of left atrial (LA) mechanical functions. This study was conducted to assess the acute impact of Balloon Mitral Valvotomy (BMV) on these functions. Methods: This single centre observational study included 25 patients with severe MS (aged 34.1 ± 7.1 years, with mean mitral valve area of 0.74 ± 0.13 cm²), in sinus rhythm, who underwent successful BMV at our hospital. Phasic LA volumes (V max : maximal LA volume, V min : minimal LA volume, and V p : LA volume at the onset of P-wave) were measured by modified Simpson's method. Parameters of LA reservoir function i.e. LA total emptying fraction (LATEF) and LA expansion index (LAEI); conduit function i.e. LA passive emptying fraction (LAPEF); and pump function i.e. LA active emptying fraction (LAAEF) were calculated from these volumes. All these parameters were evaluated before and 24-48 hours after BMV. Results: Successful BMV led to significant reduction in V max (p < 0.001), V min (p < 0.001), and V p (p < 0.001). There was a significant increase in LATEF (p= 0.001) and LAEI (p= 0.002). LAPEF increased insignificantly (p= 0.057), while there was no significant change in LAAEF (p =0.127) after BMV. Conclusion: Successful BMV leads to early improvement in left atrial reservoir and conduit functions, without significantly affecting left atrial pump function. Whether these acute changes translate into long term left atrial reverse remodelling and clinical benefits thereof needs to be established by further studies.

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Left Atrium Reverse Remodeling in Patients With Mitral Valve Stenosis After Percutaneous Valvuloplasty: A 2- and 3-Dimensional Echocardiographic Study

Cited by 12 publications

References 22 publications

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Assessment of interatrial dyssynchrony by Tissue Doppler Imaging in mitral stenosis: Effect of afterload reduction after balloon mitral valvuloplasty

Assessment of Interatrial Dyssynchrony by Tissue Doppler Imaging in Mitral Stenosis: Effect of Afterload Reduction After Balloon Mitral Valvuloplasty.

Acute Impact of Balloon Mitral Valvotomy on Left Atrial Functions in Mitral Stenosis

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