Myocardial Systolic Strain is Decreased After Aortic Valve Replacement in Patients With Aortic Insufficiency

Pomerantz, Benjamin J.; Wollmuth, Jason; Krock, Marc D.; Cupps, Brian P.; Moustakidis, Pavlos; Kouchoukos, Nicholas T.; Dávila‐Román, Víctor G.; Pasque, Michael K.

doi:10.1016/j.athoracsur.2005.05.095

Cited by 19 publications

(16 citation statements)

References 20 publications

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“…17 Briefly, applying an electrocardiogram-triggered SPAMM (Spatial Modulation of Magnetization) cine fast gradient-echo sequence (TR 58 ms/TE 2.8 ms; FA 30°, acquisition matrix 256×256) 5 to 8 contiguous stacks of short-axis images were prescribed from base to apex, and four long-axis slices were prescribed radially every 45°. 4 The images were acquired during breath holds at end-expiration at 29-ms intervals until the completion of the entire cardiac cycle at each imaging plane.…”

Section: Methodsmentioning

confidence: 99%

Accuracy and Reproducibility of Strain by Speckle Tracking in Pediatric Subjects with Normal Heart and Single Ventricular Physiology: A Two-Dimensional Speckle-Tracking Echocardiography and Magnetic Resonance Imaging Correlative Study

Singh

Cupps

Pasque

et al. 2010

Journal of the American Society of Echocardiography

115

119

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Background Myocardial strain is a sensitive measure of ventricular systolic function. Two-dimensional speckle-tracking echocardiography (2DSE) is an angle-independent method for strain measurement but has not been validated in pediatric subjects. We evaluated the accuracy and reproducibility of 2DSE-measured strain against reference tagged MRI-measured strain in pediatric subjects with normal hearts and those with single ventricle (SV) of left ventricle (LV) morphology s/p Fontan procedure. Methods Peak systolic circumferential (CS) and longitudinal (LS) strains in segments (n = 16) of LVs in age and BSA matched 20 healthy and 12 pediatric subjects with tricuspid atresia s/p Fontan procedure were measured by 2DSE and tagged MRI. Average (global) and regional segmental strains measured by two methods were compared using Spearman and Bland-Altman analyses. Results 2DSE and tagged MRI measured global strains demonstrated close agreements, which were better for LS than CS and in normal LVs than in SVs (95% limits of agreement: +0.0% to +3.12%, −2.48 % to +1.08%, −4.6% to +1.8% and −3.6% to +1.8% respectively). There was variability in agreement between regional strains with wider limits in apical than in basal regions in normal LVs and heterogeneous in SVs. The strain values were significantly (p < 0.05) higher in normal LVs than in SVs except for basal LSs, which were similar in both cohorts. The regional strains in normal LVs demonstrated an apico-basal magnitude gradient whereas SVs showed heterogeneity. The reproducibility was the most robust for images obtained with frame rates between 60 and 90 frame/sec; global LS in both cohorts; and basal strains in normal LVs. Conclusions 2DSE-measured strains agree with MRI-measured strain globally but vary regionally particularly in SVs. Global strain may be more robust tool for the cardiac function evaluation than regional strain in SV physiology. The reliability of 2DSE measured strain is affected by the frame rate, nature of strain, and ventricular geometry.

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Section: Methodsmentioning

confidence: 99%

Accuracy and Reproducibility of Strain by Speckle Tracking in Pediatric Subjects with Normal Heart and Single Ventricular Physiology: A Two-Dimensional Speckle-Tracking Echocardiography and Magnetic Resonance Imaging Correlative Study

Singh

Cupps

Pasque

et al. 2010

Journal of the American Society of Echocardiography

115

119

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“…Multiple strain indices can be simultaneously clinically assessed by these methods. Three of these indices (circumferential strain, longitudinal strain, and the minimum principal strain angle [12]) have demonstrated accuracy in the characterization of regional and transmural myocardial function [11, 15, 16]. …”

Section: Commentmentioning

confidence: 99%

Myocardial Viability Mapping by Magnetic Resonance-Based Multiparametric Systolic Strain Analysis

Cupps

Bree

Wollmuth

et al. 2008

The Annals of Thoracic Surgery

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“…Certainly waiting for global decreases in myocardial strain is unlikely to be the ideal solution as many patients with reduced global strains preoperatively, fail to normalize LV function postoperatively 21, 22, 27 . However, with an improved understanding of the injury pattern and progression associated with MR, coupled with the use of more sophisticated metrics of regional contractile function, the preservation of LV function and subsequent improved patient survival after MV surgery may become more standardized.…”

Section: Discussionmentioning

confidence: 99%

Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern

Maniar¹,

Brady²,

Lee³

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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Objectives Clinical guidelines for asymptomatic patients with chronic MR utilize ejection fraction (EF) to trigger surgical referral. We hypothesize that 1) EF is not sensitive enough to detect the earliest contractile injury in chronic MR and 2) that the injury associated with chronic MR is not global but heterogeneous, occurring regionally and predictably, prior to the onset of global left ventricular (LV) dysfunction. Methods Fifteen patients with chronic MR and normal LV EF by echocardiography underwent cardiac MRI with tissue tagging. Point-specific comparisons (at 15,300 LV grid points) of multiple strain parameters to a normal human strain database allowed normalization of patient-specific regional contractile function. Data were mapped over patient-specific 3D geometry, then averaged across six LV regions. Results Global LV longitudinal and circumferential myocardial strains were normal for all 15 MR patients when compared to normal controls (p>0.05). Despite preserved global function, the anteroseptum and posteroseptum demonstrated significantly worse contractile function when compared to other regions of the LV (p=0.003 and p=0.035, respectively). Hyper-contractile regions (lateral walls) appeared to compensate (p=0.002) for the reduced septal contractile function thereby masking injury detection by global indices. Conclusion The earliest contractile injury seen in MR patients is heterogeneous, and consistently distributed along the LV septum. Compensatory responses include hypercontractility of other regions. These data suggest that rather than relying upon global LV contractile metrics, which do not detect early injury, patients may be better served by undergoing directed surveillance of “sentinel” LV regions (LV septum) with high-resolution metrics of regional contractile function.

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Myocardial Systolic Strain is Decreased After Aortic Valve Replacement in Patients With Aortic Insufficiency

Cited by 19 publications

References 20 publications

Accuracy and Reproducibility of Strain by Speckle Tracking in Pediatric Subjects with Normal Heart and Single Ventricular Physiology: A Two-Dimensional Speckle-Tracking Echocardiography and Magnetic Resonance Imaging Correlative Study

Accuracy and Reproducibility of Strain by Speckle Tracking in Pediatric Subjects with Normal Heart and Single Ventricular Physiology: A Two-Dimensional Speckle-Tracking Echocardiography and Magnetic Resonance Imaging Correlative Study

Myocardial Viability Mapping by Magnetic Resonance-Based Multiparametric Systolic Strain Analysis

Early left ventricular regional contractile impairment in chronic mitral regurgitation occurs in a consistent, heterogeneous pattern

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