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IMPLICATIONS OF GLOBAL AND REGIONAL LEFT VENTRICULAR LONGITUDINAL STRAIN ON SURGICAL MITRAL VALVE REPAIR OUTCOMES
E1929 JACC March 12, 2013 Volume 61, Issue 10
Valvular Heart Disease Implications of Global and Regional Left Ventricular Longitudinal Strain on Surgical Mitral Valve Repair Outcomes Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Evolving Concepts for the Optimal Management of Mitral Regurgitation from E-Clip to Robotics Abstract Category: 32. Valvular Heart Disease: Therapy Presentation Number: 1111-79 Authors: Ibtihal Al Amri, Philippe Debonnaire, Tomasz Witkowski, Robert Klautz, Jerry Braun, Martin Schalij, Jeroen Bax, Nina Ajmone Marsan, Victoria Delgado, Leiden University Medical Center, Leiden, The Netherlands Aim: To investigate the impact of global and regional myocardial contractile function at the insertion level of the mitral valve papillary muscles (PM) on recurrence of significant functional mitral regurgitation (FMR) after surgical mitral valve annuloplasty (MVP). Methods: In 68 patients (age 66±8.9 years) with ischemic FMR who underwent coronary revascularization and MVP, echocardiographic speckle tracking strain analysis was used to measure global and regional LV longitudinal strain (LS) before surgery. Patients with concomitant aortic valve disease, Dor procedure or cardiac support device were excluded. Global LS was calculated by averaging the peak strain values of the 18 cardiac segments. The midposterior and midinferior segments and the midlateral and midanterior segments were used to assess regional myocardial contractile function at the level of the posteromedial and anterolateral PM, respectively. Patients were divided into two groups according to recurrence of significant FMR (Group I, n=16) and non-recurrence (Group II, n=52) at follow-up (3±2.3 years). Results: Baseline LV dimensions and function were comparable between the groups. Mean LV end-diastolic and end-systolic diameter were 63±9.0 mm and 56±11 mm, respectively, in group I vs. 56±11.4 mm and 49 ± 10.5 mm in group II (p=0.30 and p=0.06 respectively). In group I, mean LV end-diastolic and end-systolic volume were 146±72.9 ml and 100±51.9 ml, respectively vs. 141±57 ml and 85 ± 43.4 ml in group II (p=0.80 and p=0.32, respectively). Mean LV ejection fraction before surgery was also comparable between group I (36±11.9%) and group II (41±11.4%, p=0.14). However, patients in group I had significantly more impaired pre-operative global LS values as compared to group II (-10±3 % vs. -13±4 % respectively, p<0.005). Regional LS at the posteromedial PM and anterolateral PM level were also more impaired in group I than in their counterparts (-8±3% vs -12±4%, p<0.001, and -10±4% vs. -13±5%, p=0.01, respectively). Conclusions: Patients with recurrent ischemic FMR after initial successful surgical MVP show worse preoperative myocardial contractile function, both globally and at the PM level, than patients who remain free of FMR recurrence.
Valvular Heart Disease Implications of Global and Regional Left Ventricular Longitudinal Strain on Surgical Mitral Valve Repair Outcomes Poster Contributions Poster Sessions, Expo North Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Evolving Concepts for the Optimal Management of Mitral Regurgitation from E-Clip to Robotics Abstract Category: 32. Valvular Heart Disease: Therapy Presentation Number: 1111-79 Authors: Ibtihal Al Amri, Philippe Debonnaire, Tomasz Witkowski, Robert Klautz, Jerry Braun, Martin Schalij, Jeroen Bax, Nina Ajmone Marsan, Victoria Delgado, Leiden University Medical Center, Leiden, The Netherlands Aim: To investigate the impact of global and regional myocardial contractile function at the insertion level of the mitral valve papillary muscles (PM) on recurrence of significant functional mitral regurgitation (FMR) after surgical mitral valve annuloplasty (MVP). Methods: In 68 patients (age 66±8.9 years) with ischemic FMR who underwent coronary revascularization and MVP, echocardiographic speckle tracking strain analysis was used to measure global and regional LV longitudinal strain (LS) before surgery. Patients with concomitant aortic valve disease, Dor procedure or cardiac support device were excluded. Global LS was calculated by averaging the peak strain values of the 18 cardiac segments. The midposterior and midinferior segments and the midlateral and midanterior segments were used to assess regional myocardial contractile function at the level of the posteromedial and anterolateral PM, respectively. Patients were divided into two groups according to recurrence of significant FMR (Group I, n=16) and non-recurrence (Group II, n=52) at follow-up (3±2.3 years). Results: Baseline LV dimensions and function were comparable between the groups. Mean LV end-diastolic and end-systolic diameter were 63±9.0 mm and 56±11 mm, respectively, in group I vs. 56±11.4 mm and 49 ± 10.5 mm in group II (p=0.30 and p=0.06 respectively). In group I, mean LV end-diastolic and end-systolic volume were 146±72.9 ml and 100±51.9 ml, respectively vs. 141±57 ml and 85 ± 43.4 ml in group II (p=0.80 and p=0.32, respectively). Mean LV ejection fraction before surgery was also comparable between group I (36±11.9%) and group II (41±11.4%, p=0.14). However, patients in group I had significantly more impaired pre-operative global LS values as compared to group II (-10±3 % vs. -13±4 % respectively, p<0.005). Regional LS at the posteromedial PM and anterolateral PM level were also more impaired in group I than in their counterparts (-8±3% vs -12±4%, p<0.001, and -10±4% vs. -13±5%, p=0.01, respectively). Conclusions: Patients with recurrent ischemic FMR after initial successful surgical MVP show worse preoperative myocardial contractile function, both globally and at the PM level, than patients who remain free of FMR recurrence.