Additional features of echocardiographic assessment of left ventricular systolic function inpatients with moderate mitral regurgitation before and after surgical myocardial revascularizationand mitral annuloplasty

Authors: S.G. Sukhanov 1,2, 2, E.N. Orekhova 1,2, 2, S.A. Sharlaimov 2

Company: 1 Аcademician E.A. Wagner Perm State Medical Academy of Ministry of Health of the Russian Federation; ulitsa Petropavlovskaya, 26, Perm, 614000, Russian Federation; 2 Federal Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation; ulitsa Marshala Zhukova, 35, Perm, 614013, Russian Federation


For citation: Sukhanov S.G., Orekhova E.N., Sharlaimov S.A. Additional features of echocardiographic assessment of left ventricular systolic function in patients with moderate mitral regurgitation before and after surgical myocardial revascularization and mitral annuloplasty. Creative Cardiology. 2014; 1: 24-35

Keywords: longitudinal strain systolic function mitral annuloplasty

Full text:  

 

Abstract

Purpose. Comprehensive echocardiographic assessment of left ventricular (LV) systolic function in patients with moderate mitral regurgitation before and after surgical revascularization and mitral annuloplasty. Material and methods. The study involved 58 patients with moderate mitral insufficiency and no signs of significant left ventricular remodeling. Depending on the operating surgeon tactics against further intervention on the mitral valve patients were divided into 2 groups of observations: group 1 (n=28) – isolated coronary artery bypass grafting; group 2 (n=30) – coronary artery bypass grafting and mitral annuloplasty. In echocardiographic evaluation included standard measurement and assessment of global and segmental left ventricular function, as well as the use of techniques speckle tracking and tissue Doppler to measure speed of the fibrous ring of the mitral valve. Results. The result was a significant decrease in overall left ventricular ejection fraction (LVEF) in group 2 in the early postoperative period. In the mid-term total LVEF has improved, but did not reach baseline values. Also in the early period of observation calculated LVEF showed significant improvement compared with baseline, but did not change significantly with further observation and was comparable to the control group. Compared with the original data in the early period of observation there was a reduction of global longitudinal strain in both groups, but more pronounced in group 2. In the medium to longterm follow global longitudinal strain showed an increase, but remained lower than baseline. Conclusions. Some parameters, such as left ventricular end-systolic volume, are dependent on afterload affect the accuracy in the evaluation of left ventricular systolic function to mitral valve annuloplasty. LV global longitudinal strain indicators may help to identify LV dysfunction at an early stage, before it happens a significant and irreversible myocardial injury.

References

1. Bonow R.O., Carabello B.A., Chatterjee K.С., Antonio C.L., David P.F., Michael D.F. et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2006; 48: 1–148. 2. Vahanian A., Alfieri O., Andreoti F., Antunes M., Baron-Esquivias G., Baumgartner H. et al. Guidelines on the management of valvular heart disease: (version 2012). The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2012; 33: 2451–96. 3. Bruch C., Stypmann J., Gradaus R., Breithardt G., Wichter T. Impact of stroke volume on mitral annular velocities derived from tissue Doppler imaging. Heart. 2005; 91 (2): 243–4. 4. Cheng A., Nguyen T.C., Malinowski M., Liang D., Daughters G.T., Ingels N.B. et al. Undersized mitral annuloplasty inhibits left ventricular basal wall thickening but does not affect equatorial wall cardiac strains. J. Heart Valve Dis. 2007; 16 (4): 349–58. 5. Suri R.M., Schaff H.V., Dearani J.A., Sundt T.M. 3rd, Daly R.C., Mullany C.J. et al. Determinants of early decline in ejection fraction after surgical correction of mitral regurgitation. J. Thorac. Cardiovasc. Surg. 2008; 136 (2): 442–7. 6. Reisner S.A., Lysyansky P., Agmon Y., Mutlak D., Lessick J., Friedman Z. Global longitudinal strain: a novel index of leftventricular systolic function. J. Am. Soc. Echocardiogr. 2004; 17 (6): 630–3. 7. Marciniak A., Claus P., Sutherland G.R., Marciniak M., Karu T., Baltabaeva A. et al. Changes in systolic left ventricular function in isolated mitral regurgitation. A strain rate imaging study. Eur. Heart J. 2007; 28 (21): 2627–36. 8. Lang R.M., Bierig M., Devereux R.B., Flachskampf F.A., Foster E., Pellikka P.A. et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J. Am. Soc. Echocardiogr. 2005; 18 (12): 1440–63. 9. Бокерия Л.А., Голухова Е.З. (ред.) Клиническая кардиология: диагностика и лечение. В 3 т. М.: НЦССХ им. А.Н. Бакулева РАМН; 2011: 612. 10. Бокерия Л.А., Голухова Е.З. (ред.) Клиническая кардиология: диагностика и лечение. В 3 т. М.: НЦССХ им. А.Н. Бакулева РАМН; 2011: 487. 11. Алехин М.Н. Ультразвуковые методы оценки деформации миокарда и их клиническое значение. М.: Видар; 2012: 88. 12. Marciniak A., Sutherland G.R., Marciniak M., Kourliouros A., Bijnens B., Jahangiri M. Prediction of postoperative left ventricular systolic function in patients with chronic mitral regurgitation undergoing valve surgery: the role of deformation imaging. Eur. J. Cardiothorac. Surg. 2011; 40 (5): 1131–7. 13. Magne J., Senechal M., Dumesnil J.G., Pibarot P. Ischemic mitral regurgitation: a complex multifaceted disease. Cardiology. 2009; 112 (4): 244–59. 14. Bolling S.F., Pagani F.D., Deeb G.M., Bach D.S. Intermediate-term outcome of mitral reconstruction in cardiomyopathy. J. Thorac. Cardiovasc. Surg. 1998; 115 (2): 381–6. 15. Yiu S.F., Enriquez-Sarano M., Tribouilloy C., Seward J.B., Tajik A.J. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation. 2000; 102 (12): 1400–6. 16. Choi J.O., Shin D.H., Cho S.W., Song Y.B., Kim J.H., Kim Y.G. et al. Effect of preload on left ventricular longitudinal strain by 2D speckle tracking. Echocardiography. 2008; 25 (8): 873–9. 17. McGinley J.C., Berretta R.M., Chaudhary K., Rossman E., Bratinov G.D., Gaughan J.P. et al. Impaired contractile reserve in severe mitral valve regurgitation with a preserved ejection fraction. Eur. J. Heart Fail. 2007; 9 (9): 857–64. 18. Gaasch W.H., Meyer T.E. Left ventricular response to mitralregurgitation: implications for management. Circulation. 2008; 118 (22): 2298–303. 19. Suri R.M., Schaff H.V., Dearani J.A., Sundt T.M., Daly R.C., Mullany C.J. et al. Recovery of left ventricular function after surgical correction of mitral regurgitation caused by leaflet prolapse. J. Thorac. Cardiovasc. Surg. 2009; 137 (5): 1071–6. 20. Starling M.R. Effects of valve surgery on left ventricular contractile function in patients with long-term mitral regurgitation. Circulation. 1995; 92 (4): 811–8. 21. Enriquez-Sarano M., Bailey K.R., Seward J.B., Tajik A.J., Krohn M.J., Mays J.M. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993; 87 (3): 841–8. 22. Donal E., Bergerot C., Thibault H., Ernande L., Loufoua J., Augeul L. et al. Influence of afterload on left ventricular radial and longitudinal systolic functions: a two-dimensional strain imaging study. Eur. J. Echocardiogr. 2009; 10 (8): 914–21.

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery