Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

Putra, Teuku Muhammad Haykal; Sukmawan, Renan; Elen, Elen; Atmadikoesoemah, Celly Anantaria; Desandri, Dwita Rian; Kasim, Manoefris

doi:10.1055/s-0039-1693457

Cited by 5 publications

(16 citation statements)

References 37 publications

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“…Aschoff nodules are pathognomonic findings in RHD. Another study showed that preoperative myocardial fibrosis was identified in 91.5% of MS patients [12]. Myocardial fibrosis identified by late gadolinium enhancement (LGE) protocol was a nonischemic pattern, and most of them were described as patchy myocardial fibrosis that varied across every segment of LV [12].…”

Section: Discussionmentioning

confidence: 99%

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Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

et al. 2023

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Background: Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established.Purpose: Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods:The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results:The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions:Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.

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Section: Discussionmentioning

confidence: 99%

“…Aschoff nodules are pathognomonic findings in RHD. Another study using magnetic resonance imaging (MRI) showed myocardial fibrosis in patients with rheumatic mitral stenosis (MS) who did not have ischemic heart disease [12]. This finding shows that there was an inflammatory process in the myocardium that eventually led to fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

et al. 2023

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“…This result is not very different from the results in some previous investigations that recruited a subset of patients similar to that in our research (91.5%). 14 However, other epidemiological studies regarding this topic have provided very different numbers. A previous study stated that the prevalence of myocardial fibrosis detected by necropsy analysis among patients with rheumatic heart disease (RHD) was only 19.9%.…”

Section: Discussionmentioning

confidence: 99%

“… 13 Furthermore, this issue is also applicable to patients with rheumatic MS who undergo mitral valve surgery as was described in previous publications with a similar subset of patients to this research. 14 Despite the established association between myocardial fibrosis and the clinical outcome after heart surgery, we still have no evidence whether it affects the LV anatomically.…”

Section: Introductionmentioning

confidence: 99%

“…This issue has already been established by our previous publication. More extensive myocardial fibrosis is associated with postoperative morbidity after mitral valve surgery in patients with rheumatic MS. 14 Therefore, the clinical outcome after surgery is not what we tried to investigate. Cardiologists and surgeons expect the drastic recovery of preload after the surgical removal of the restrictive flow in the mitral valve.…”

Section: Introductionmentioning

confidence: 99%

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Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: the Impact of Myocardial Fibrosis

Putra¹,

Sukmawan²,

Desandri³

et al. 2020

JTHC

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Background: Patients with rheumatic mitral stenosis (MS) experience changes in left ventricular (LV) dimensions after mitral valve surgery. We sought to investigate changes in LV dimensional parameters after mitral valve surgery and find out whether the same changes occurred in different extents of myocardial fibrosis. Methods: This prospective observational study comprised 43 patients with rheumatic MS planned for mitral valve surgery between October 2017 and April 2018 in National Cardiovascular Center Harapan Kita (NCCHK) Jakarta. All the patients underwent cardiac magnetic resonance imaging based on the late gadolinium enhancement (LGE) protocol for myocardial fibrosis assessment prior to surgery. The patients were classified according to the estimated fibrosis volume considered to influence hemodynamic performance (myocardial fibrosis <5% and myocardial fibrosis ≥5%). Serial transthoracic echocardiographic examinations before and after surgery were performed to detect changes in LV dimensional parameters. Results: This study consisted of 31 (72.1%) women and 12 (27.9%) men at a mean age of 46±9 years. The LGE protocol revealed myocardial fibrosis of less than 5% in 32 (74.4%) patients. A significant increase was detected in the LV end-diastolic diameter postoperatively, specifically in the patients with myocardial fibrosis of less than 5% (44.0±4.8 mm vs 46.6±5.6 mm; P value=0.027). A similar significant increase was not found in the other group (45.0±6.6 mm vs 46.7±6.9 mm; P value=0.256). Other changes in echocardiographic parameters showed similar patterns in both groups. Conclusion: Our patients with rheumatic MS who had myocardial fibrosis of less than 5% demonstrated better improvements in terms of increased preload. Myocardial fibrosis of less than 5% is associated with more favorable improvements in LV geometry.

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Cardiac imaging in rheumatic heart disease and future developments

Seitler

Zuhair

Shamsi

et al. 2023

European Heart Journal Open

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Rheumatic Heart Disease (RHD) is the most common cause of valvular heart disease worldwide, affecting millions, especially in low- and middle-income countries. Multiple imaging modalities such as Cardiac CT, Cardiac MRI and three-dimensional echocardiography may be utilised in diagnosing, screening, and managing RHD. However, two-dimensional transthoracic echocardiography remains the cornerstone of imaging in RHD. Criteria developed by the World Heart Foundation in 2012 sought to unify the diagnostic imaging criteria for RHD, but concerns remain regarding their complexity and reproducibility. In the intervening years, further measures have been developed to find a balance between simplicity and accuracy. Nonetheless, there remain significant unresolved problems within imaging in RHD, including the development of a practical and sensitive screening tool to identify patients with RHD. The emergence of handheld echocardiography has the potential to revolutionise RHD management in resource-poor settings, but its role as a screening or diagnostic tool is yet to be fully established. The dramatic evolution of imaging modalities over the last few decades has not addressed RHD compared to other forms of structural heart disease. In this review, we examine the current and latest developments concerning cardiac imaging and RHD.

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Prognostic Value of Late Gadolinium Enhancement in Postoperative Morbidity following Mitral Valve Surgery in Rheumatic Mitral Stenosis

Cited by 5 publications

References 37 publications

Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

Left Ventricular Dimension after Mitral Valve Surgery in Rheumatic Mitral Stenosis: the Impact of Myocardial Fibrosis

Cardiac imaging in rheumatic heart disease and future developments

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