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Mitral annular longitudinal function preservation after mitral valve repair: the MARTE study
Department of Cardiovascular Disease, University of Siena, Italy.
Department of Cardiology, Santa Maria Annunziata Hospital, Firenze, Italy.
Department of Cardiovascular Disease, University of Siena, Italy.
Division of Cardiac Surgery, University of Siena, Italy.
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2012 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 157, no 2, 212-215 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In patients with chronic mitral regurgitation (MR), undergoing surgical mitral valve repair, current Guidelines only recommend standard echocardiographic indices i.e. left ventricular (LV) ejection fraction (EF), and LV end-systolic and end-diastolic diameters as preoperative variables. However LV EF is often preserved until advanced stages of the valve disease. Aim of this study was to evaluate changes in LV systolic longitudinal function, 3months after mitral valve repair in patients with chronic degenerative MR and normal preoperative EF.

METHODS: We measured M-mode mitral lateral annulus systolic excursion (MAPSE) and Tissue Doppler (TD) peak systolic annular velocity (S(m)) in 31 patients with moderate to severe MR and normal EF (59.9±4.7%) candidates for mitral valve repair, preoperatively and 3months after surgery.

RESULTS: After mitral valve repair, S(m) increased from 7.8±1.4 to 9.6±2.2cm/s (p<0.0001) and MAPSE increased from 1.33±0.26 to 1.55±0.25cm (p=0.0013). EF decreased from 59.9±4.7 to 51.3±5.9% (p<0.0001). As expected, LV diameters and volumes, wall thicknesses, midwall fractional shortening (mFS), and left atrial (LA) size were all reduced after surgery.

CONCLUSIONS: This study suggests that assessment of LV long axis systolic velocity and amplitude of excursion by echocardiography is more sensitive than simple determination of EF for revealing the beneficial impact of MR surgery on overall systolic function.

Place, publisher, year, edition, pages
Elsevier, 2012. Vol. 157, no 2, 212-215 p.
Keyword [en]
Longitudinal function; Mitral valve
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-39687DOI: 10.1016/j.ijcard.2010.12.054PubMedID: 21194764OAI: oai:DiVA.org:umu-39687DiVA: diva2:394706
Available from: 2011-02-03 Created: 2011-02-03 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Insights into left atrial response to pressure and volume overload
Open this publication in new window or tab >>Insights into left atrial response to pressure and volume overload
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general purpose of this thesis is to establish the ability of Speckle Tracking Echocardiography (STE) in assessing left atrial (LA) response to pressure and volume overload respectively in aortic stenosis (AS) and mitral regurgitation (MR), and to evaluate its accuracy in predicting LA and right ventricular (RV) fibrosis in patients with end-stage heart failure (HF) undergoing heart transplantation (HTx).

I demonstrated that assessment of left ventricular (LV) long axis systolic velocity and amplitude of excursion is more sensitive than simple determination of ejection fraction (EF) for revealing the beneficial impact of MR surgery on overall LV systolic performance.

Severe symptomatic AS is associated with LA enlargement and compromised mechanical function with a high incidence of peri-operative atrial fibrillation (AF). Valve replacement reverses these abnormalities and regains normal atrial function, a behaviour which is directly related to the severity of pre-operative LV outflow tract obstruction. Early identification of LA size and function disturbances, as shown by myocardial strain measurements might contribute to better patient’s recruitment for a safe valve replacement.

In late stage HF patients, the right ventricle is enlarged, with reduced systolic function due to significant myocardial fibrosis. RV free wall myocardial deformation is the most accurate function measure that correlates with the extent of RV myocardial fibrosis and functional capacity.

In patients with preserved EF, severe MR masks LV and LA myocardial dysfunction and correlates with symptoms and post-operative cavity function instability. Three months after MVR, the underlying myocardial disturbances are unmasked suggesting that most pre-operative measurements are subject to loading conditions. Finally LA volume and PALS remain the main predictors of post-operative AF, thus should be used for stratifying surgical risk.

STE has been shown to accurately determine the severity of impairment of LA myocardial function shown by suppressed PALS which was the strongest predictor of the presence and extent of fibrosis, over and above other structure and function parameters. These findings may assist in better stratifying patients with end stage HF and identifying particularly those requiring HTx.

Place, publisher, year, edition, pages
Umeå: University of Umeå, 2016. 138 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1863
Keyword
Keywords Mitral regurgitation, aortic stenosis, speckle tracking echocardiography, heart transplantation, left atrial strain, left ventricualr function, right ventricular function, myocardial fibrosis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-127294 (URN)978-91-7601-610-7 (ISBN)
Public defence
2016-12-01, Sal C, Unod T9, Norrlands Universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2016-11-10 Created: 2016-11-04 Last updated: 2016-11-21Bibliographically approved

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