Mitral regurgitation in dilated cardiomyopathy: value of both regional left ventricular contractility and dyssynchrony

Donal, Erwan; Place, C. De; Kervio, Gaëlle; Gervais, Renaud; Leclercq, Christophe; Mabo, Philippe; Daubert, Jean‐Claude

doi:10.1093/ejechocard/jen188

Cited by 36 publications

(21 citation statements)

References 31 publications

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“…Mitral orifice and LV characteristics such as longitudinal contractility and asynchrony were identified as determining factors of functional MR [24]. In contrast, MR itself causes torsional alterations.…”

Section: Discussionmentioning

confidence: 99%

Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis

Spasova¹,

Borizanova²,

Goudev³

2018

Cardiology

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Left ventricular (LV) twist serves as a compensatory mechanism in systolic dysfunction and its degree of reduction may reflect a more advanced stage of disease. Aim: The aim was to investigate twist alterations depending on the degree of functional mitral regurgitation (MR) by speckle-tracking echocardiography. Methods: Sixty-three patients with symptomatic dilated cardiomyopathy (DCM) were included. Patients were divided according to MR vena contracta width (VCW): group 1 with VCW <7 mm (mild/moderate MR) and group 2 with VCW ≥7 mm (severe MR). Results: There were no differences in LV geometry and function between groups. Group 2 showed lower endocardial basal rotation (BR) (–2.04° ± 1.83° vs. –3.23° ± 1.83°, p = 0.012); epicardial BR (–1.54° ± 1.18° vs. –2.31° ± 1.22°, p = 0.015); endocardial torsion (0.41°/cm ± 0.36°/cm vs. 0.63°/cm ± 0.44°/cm, p = 0.033) and mid-level circumferential strain (CSmid) (–6.12% ± 2.64% vs. –7.75% ± 2.90%, p = 0.028), when compared with group 1. Multivariable linear regression analysis identified endocardial BR, torsion and CSmid, as the best predictors of larger VCW. In the ROC curve analysis, endocardial BR and CSmid values greater than or equal to –3.63° and –9.35%, respectively, can differentiate patients with severe MR. Conclusions: In DCM patients, torsional profile was more altered in severe MR. Endocardial BR, endocardial torsion, and CSmid, can be used as indicators of advanced structural wall architecture damage.

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Section: Discussionmentioning

confidence: 99%

Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis

Spasova¹,

Borizanova²,

Goudev³

2018

Cardiology

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“…Notably, LV dilatation and impaired contraction 5 as well as PM dyssynchrony 6 has been also regarded as determinants of functional MR severity since they lead to MV tethering. In the present study, we did not observe substantial changes of LV dimensions and inter-PM distances after NIMR creation (Figure 6).…”

Section: Discussionmentioning

confidence: 99%

Creation of Nonischemic Functional Mitral Regurgitation by Annular Dilatation and Nonplanar Modification in a Chronic In Vivo Swine Model

et al. 2013

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Background Mechanisms and treatments of nonischemic functional mitral regurgitation (NIMR) are not fully established in part due to a lack of proper large animal models. We developed a novel technique of NIMR creation in a swine model by making multiple small incisions in the mitral annulus. Methods and Results Ex-vivo experiments using isolated swine hearts (n=10) showed a 15% increase in annular area (6.8 to 7.8cm2) after 16 incisions were made along the posterior mitral annulus of a pressurized left ventricle (LV). In an in vivo swine model (n=7, 46.4±2.2kg) NIMR was created by making 14-26 2mm incisions in the atrial aspect of the mitral annulus using a cardioport video-assisted imaging system in the beating heart. Animals were sacrificed at 4 weeks (n=4) and 6 weeks (n=3). Three-dimensional (3D) echocardiography was obtained before and immediately after NIMR creation, and at euthanasia; vena contracta area (VCA), mitral annular dimension, LV volume, and inter-papillary muscle distance were measured. The mitral annular incisions resulted in mild-moderate mitral regurgitation and an increased VCA. NIMR creation altered mitral valve (MV) geometry by decreasing mitral annular nonplanarity and increasing annular area, primarily in the anteroposterior dimension. NIMR creation did not significantly change LV volume or inter-papillary muscle distance. Longer follow-up period did not significantly affect these outcomes. Conclusions NIMR can successfully be created in a beating-heart swine model and results in dilatation and 3D changes in mitral annular geometry. This model can enhance the experimental validation of new valve repair devices and techniques.

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“…[73][74][75] Recent publications describe the prognostic importance of functional mitral regurgitation, a feature of DCM related to LV geometry, contractility and dyssynchrony. 76 77 Rossi et al demonstrate, in non-ischaemic DCM, that functional mitral regurgitation is associated with doubling of a combined end point of all-cause mortality hospitalisation and worsening heart failure. 74 …”

Section: Treatmentmentioning

confidence: 99%

Cardiomyopathies the national society journals present selected research that has driven recent advances in clinical cardiology

Elliott¹,

Mohiddin²

2012

Srce i krvni sudovi

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Mitral regurgitation in dilated cardiomyopathy: value of both regional left ventricular contractility and dyssynchrony

Abstract: The MR of the dilated cardiomyopathy is multifactorial. Our data suggest that analysing only LV geometry and mitral orifice is insufficient to correctly describe functional MR determinant. LV contractility and dyssynchrony are essential too.

Cited by 36 publications

References 31 publications

Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis

Torsion Mechanics as an Indicator of More Advanced Left Ventricular Systolic Dysfunction in Secondary Mitral Regurgitation in Patients with Dilated Cardiomyopathy: A 2D Speckle-Tracking Analysis

Creation of Nonischemic Functional Mitral Regurgitation by Annular Dilatation and Nonplanar Modification in a Chronic In Vivo Swine Model

Cardiomyopathies the national society journals present selected research that has driven recent advances in clinical cardiology

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