Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects—Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

Abstract

Background: The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV strains, quantitative features of longitudinal contractility and MA size and function in healthy subjects. Methods: The present study comprised 295 healthy adults; 117 subjects were excluded due to inferior image quality (40%). Finally, 178 healthy adults (mean age: 32.0±11.3 years, 92 males). Complete twodimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases. Results: The global and mean segmental left ventricular longitudinal strain (LV-LS) proved to be −16.1%±2.5% and −16.9%±2.4%, respectively. In the present study, LV-LS ≤−13% was considered to be reduced. In ROC analysis, the cutoff value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity and 69% specificity and ROC area under curve 0.73 (P=0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤−13%. Significantly larger ratio of subjects with global LV-LS ≤−13% had MAFAC ≤44% (31% vs. 67%, P=0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤−13% (4% vs. 16%, P=0.009). Conclusions: There is a strong relationship between MA and LV longitudinal function. MA fractional area change predicts global LV-LS.

Normal reference values of three‐dimensional speckle‐tracking echocardiography‐derived mitral annular dimensions and functional properties in healthy adults: Insights from the MAGYAR‐Healthy Study

“…More and more 3DSTE‐based clinical data are available in different pathological conditions together with normal reference values of left ventricular (LV), 3‐5 left atrial (LA), 6 and right atrial (RA) 7,8 volumes/volume‐based functional properties, 8 strains, 3,4,6,7 and rotational variables 5 in healthy adults, as well as their vendor‐dependency 9 . Moreover, the clinical usefulness of 3DSTE in the assessment of mitral annular dimensions and its close relationship to LV function was also confirmed 10 . However, there is a limited number of transthoracic echocardiographic studies determining MA dimensions in healthy subjects 11,12 .…”

“…Both methods are capable for volumetric measurements, but 3DSTE is useful for simultaneous assessments of strain and rotational variables using the same virtual 3D heart chamber cast. Moreover, both RT3DE and 3DSTE allow planimetric measurements, especially for determining MA dimensions 10,18 . Although many clinical studies are available with RT3DE, mainly with transesophageal approach, 19 clinical data related to 3DSTE are limited as regards the assessment of MA 10 …”

“…Following 3D optimizations using valvular edges, the typical 2D projected D‐shape of the MA could be depicted, allowing its accurate assessment with 3DSTE 10 . Thus, not only optimal MA diameter, but also MA area and perimeter by planimetry could be determined at the same time using the same 3D dataset.…”

“…Following optimization of image planes on lateral and septal MA endpoints on apical two‐ and four‐chamber views, measurements were performed on the C7 short‐axis view (Figure 1). 10 …”

“… With recently available 3DSTE systems, image quality is better in 2D than in 3D mode, affecting the results 1 . Moreover, the results can only be applied to the Toshiba equipment we used. As mentioned above, only 2D MA projection was evaluated during 3DSTE analysis, not its real 3D saddle shape 10 The present study did not aim to compare 2D‐ and 3DSTE‐derived MA dimensions. We included a limited number of cases older than 50 years, and none over 60 years. Although 3DSTE could combine volumetric and strain assessments allowing more detailed analysis from the same 3D echocardiographic dataset 3‐8 for MA featuring, no volumes or strains of other heart chambers were assessed in the present study. …”