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Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation
Author(s) -
Florescu Maria,
Benea Diana Crina Ciresica Mihaela,
Rimbas Roxana Cristina,
Cerin Gheorghe,
Diena Marco,
Lanzzillo Guido,
Enescu Oana Aurelia,
Cinteza Mircea,
Vinereanu Dragos
Publication year - 2012
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/j.1540-8175.2011.01563.x
Subject(s) - asymptomatic , cardiology , medicine , ejection fraction , radial stress , speckle tracking echocardiography , mitral regurgitation , heart failure , mitral valve , systole , blood pressure , deformation (meteorology) , diastole , physics , meteorology
Aims: In asymptomatic patients with severe primary mitral regurgitation (PMR), early detection of left ventricular (LV) dysfunction indicates the optimal timing of mitral valve surgery; however, normal ejection fraction (EF) and end‐systolic diameter (ESD) can mask significant LV impairment. Methods: We studied 28 asymptomatic patients (59 ± 13 years, 18 male) with severe PMR, EF > 60%, and ESD < 45 mm, and 10 age‐matched healthy subjects. All underwent echocardiography with tissue velocity imaging to assess LV geometry, EF, and longitudinal systolic function; and two‐dimensional speckle tracking to assess longitudinal strain (LS) and longitudinal strain rate (LSR), and radial strain (RS) and radial strain rate (RSR). Patients were reevaluated 14 days after successful mitral valve repair and divided in: IA, with a postoperative EF reduction >10% (13 patients) and IB, with an EF reduction <10% (15 patients). Results: Patients with PMR had longitudinal dysfunction and decreased radial systolic deformation, by comparison with controls, although EF and ESD were similar. Subgroup IA had significantly lower S TVI , LS, and RS than IB (7.3 ± 0.9 vs 10.8 ± 1.5 m/s; −16.0 ± 4.2% vs −21.7 ± 2.1%; and 37.4 ± 2.5% vs 41.6 ± 2.4%; all p < 0.001) although preoperative LV mass index, LV diameters, and EF were similar. Multiple stepwise regression analysis showed that S TVI and the combination of S TVI and LS represent the main independent predictors for a postoperative EF reduction >10% (r 2 = 0.52, p < 0.001; and r 2 = 0.70, p < 0.001, respectively). Conclusion: Myocardial systolic velocities as well as radial and longitudinal LV deformation assessed by speckle tracking can detect subclinical LV dysfunction and predict impaired postoperative LV function in asymptomatic patients with severe PMR. (Echocardiography 2012;29:326‐333)