Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation

Borg, Alexander; Harrison, James; Argyle, Rachel; Pearce, Keith; Beynon, Rhys; Ray, Simon

doi:10.1093/ejechocard/jeq012

Cited by 12 publications

(7 citation statements)

References 39 publications

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“…FAC LA pas is related to left ventricular early diastolic filling. In man, this parameter decreases with age and mitral valve stenosis, whereas early diastolic filling is increased in case of mitral regurgitation . The lower FAC LA act and FS LA act associated with recurrence reflect atrial contractile dysfunction.…”

Section: Discussionmentioning

confidence: 96%

Risk Factors for Recurrence of Atrial Fibrillation in Horses After Cardioversion to Sinus Rhythm

Decloedt

Schwarzwald

Clercq

et al. 2015

Veterinary Internal Medicne

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BackgroundAlthough atrial fibrillation (AF) can be successfully treated in horses, recurrence occurs frequently. In humans, atrial function after cardioversion can predict recurrence.ObjectivesTo examine the prognostic value of atrial mechanical function at 24 hours after cardioversion and other potential predictor variables for AF recurrence in horses.Animals117 horses treated for AF at 4 referral centers.MethodsRetrospective study. Inclusion criteria were successful cardioversion, echocardiography at 24 hours after cardioversion and ≥4 months follow‐up. To determine factors associated with AF recurrence, a multivariable survival model was built.Results133 AF episodes in 117 horses were included. AF recurred in 36/100 horses with a first AF episode and in 57/133 AF episodes overall. Factors associated with recurrence in horses with a first episode were previous unsuccessful treatment attempt (hazard ratio HR 2.36, 95% confidence interval CI 1.11–4.99, P = .025) and mild or moderate mitral regurgitation (HR 2.70, 95% CI 1.23–5.91, P = .013). When the last AF episode of all horses was included, previous AF (HR 2.53, 1.33–4.82, P = .005) and active left atrial fractional area change ≤9.6% (HR 3.43, 1.22–9.67, P = .020) were significant predictors.Conclusions and Clinical ImportanceThe only echocardiographic variable of left atrial function with significant prognostic value for recurrence was low active left atrial fractional area change. Further research is necessary to evaluate whether echocardiography at a later timepoint could provide more prognostic information.

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Section: Discussionmentioning

confidence: 96%

Risk Factors for Recurrence of Atrial Fibrillation in Horses After Cardioversion to Sinus Rhythm

Decloedt

Schwarzwald

Clercq

et al. 2015

Veterinary Internal Medicne

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“…These risk factors included obesity, systemic hypertension, type 2 diabetes mellitus, permanent atrial fibrillation, aortic and/or mitral valve disease, and coronary artery disease. [11][12][13][14][15][16] Systemic hypertension was defined by systolic blood pressure of >140 mmHg and/or diastolic blood pressure of >90 mmHg recorded in more than two measurements, by physician-documented history of hypertension, or by chronic use of antihypertensive medications. Diabetes mellitus was defined by the presence of a physiciandocumented history or prescription of oral hypoglycemic agents or insulin for the treatment of hyperglycemia.…”

Section: Methods Study Design: Definitionsmentioning

confidence: 99%

Response to Pulmonary Arterial Hypertension Drug Therapies in Patients with Pulmonary Arterial Hypertension and Cardiovascular Risk Factors

et al. 2014

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The age at diagnosis of pulmonary arterial hypertension (PAH) and the prevalence of cardiovascular (CV) risk factors are increasing. We sought to determine whether the response to drug therapy was influenced by CV risk factors in PAH patients. We studied consecutive incident PAH patients (n = 146) between January 1, 2008, and July 15, 2011. Patients were divided into two groups: the PAH-No CV group included patients with no CV risk factors (obesity, systemic hypertension, type 2 diabetes mellitus, permanent atrial fibrillation, mitral and/or aortic valve disease, and coronary artery disease), and the PAH-CV group included patients with at least one. The response to PAH treatment was analyzed in all the patients who received PAH drug therapy. The PAH-No CV group included 43 patients, and the PAH-CV group included 69 patients. Patients in the PAH-No CV group were younger than those in the PAH-CV group (P < 0.0001). In the PAH-No CV group, 16 patients (37%) improved on treatment and 27 (63%) did not improve, compared with 11 (16%) and 58 (84%) in the PAH-CV group, respectively (P = 0.027 after adjustment for age). There was no difference in survival at 30 months (P = 0.218). In conclusion, in addition to older age, CV risk factors may predict a reduced response to PAH drug therapy in patients with PAH.

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“…The idea of early surgery in patients with MV regurgitation is to prevent occurrence of myocardial dysfunction preceding heart failure. Nevertheless, previous literature suggests unnoticed diastolic and systolic dysfunction due to myocardial stiffness and decreased fillings rates, as a result of enhanced LV filling and increased chamber compliance already in the early stages of MV regurgitation ( 36 , 37 ). In addition, the valvular–ventricular interaction changes after MV surgery may influence LV function.…”

Section: Discussionmentioning

confidence: 97%

Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair

et al. 2018

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BackgroundClinical decision-making in symptomatic patients after mitral valve (MV) repair remains challenging as echocardiographic reference values are lacking. In native MV disease intervention is recommended for mean transmitral pressure gradient (TPG) >15 mmHg or systolic pulmonary artery pressure (SPAP) >60 mmHg at peak exercise. Insight into standard stress echo parameters after MV repair may therefore aid to clinical decision-making during follow-up.HypothesisStress echocardiography derived parameters in asymptomatic patients after successful MV repair differ from current guidelines for native valves.Material and methodsIn 25 patients (NYHA I) after MV repair stress echocardiography was performed on a semi-supine bicycle. Doppler flow records and MV related hemodynamics at rest and peak were obtained. Linear regression analysis was performed for mean TPG and SPAP at peak, using predetermined variables and confounders.ResultsMean TPG at rest (3.2 ± 1.4 mmHg) significantly increased at peak (15.0 ± 3.4 mmHg) but was always <25 mmHg. Mean SPAP at rest (21.4 ± 3.8 mmHg) significantly increased at peak (41.8 ± 8.9 mmHg) but was never >57 mmHg. Only the indexed MV ring diameter was inversely correlated to mean TPG at peak in a multivariable model.ConclusionIn contrast to current recommendations in native MV disease, our data indicate that the standard value for mean TPG during stress echocardiography in asymptomatic patients after successful MV repair was above the guideline threshold of 15 mmHg in >50%, but always <25 mmHg. For SPAP, patients never reached the guideline cutoff (60 mmHg). Long-term follow-up data are needed to provide insight in clinical consequences. Baseline stress echocardiography may indicate individual reference values to compare with during follow-up.Clinical trial registration.

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Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation

Abstract: In chronic MR, novel echocardiographic measurements of early diastolic function exhibit a biphasic pattern depending on the state of LV systolic function, and may prove useful in the timing of surgery.

Cited by 12 publications

References 39 publications

Risk Factors for Recurrence of Atrial Fibrillation in Horses After Cardioversion to Sinus Rhythm

Risk Factors for Recurrence of Atrial Fibrillation in Horses After Cardioversion to Sinus Rhythm

Response to Pulmonary Arterial Hypertension Drug Therapies in Patients with Pulmonary Arterial Hypertension and Cardiovascular Risk Factors

Reference Values for Physical Stress Echocardiography in Asymptomatic Patients after Mitral Valve Repair

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