- Email: [email protected]
Left atrial strain assessed by tow-dimensional speckle tracking echocardiography in patients with severe mitral stenosis
252
Archives of Cardiovascular Diseases Supplements (2017) 9, 251-254
Abstract 30 – Figure – Observed vs. expected mortality rates in women (a) and in men (b) with severe primary MR under medical treatment.
Abstract 31 – Figure 1 – GLS evolution 6 months after AVR regarding baseline GLS Methods The European Translink FP7 project prospectively included patients with aortic stenosis scheduled for surgical or percutaneous AVR. The present substudy included all patients enrolled in our center. Patients were separated in two groups regarding baseline left ventricle (LV) GLS value (normal ≤ or altered >– 16%). Cardiac remodelling and GLS were evaluated 6 months after AVR.
32
Results We included 200 patients (64% men, mean age 74±9 years) and 6 months follow up was completed in 127. LVEF at baseline was 62±10% and GLS –16.1±3.7%. Patients with baseline impaired GLS (n=85, 43%) were more often diabetics and obese, and had higher NT-proBNP levels. Cardiac cavities remodelling was more pronounced and LVEF was moderately decreased. These patients experienced a significant improvement in GLS at 6 months (– 15.3±3.8 VS –12.9±2.3%; p<0.0001), in contrast with patients with normal GLS at baseline (–18.7±1.6 VS –18.1±2.6%; p=0.07). Baseline LVEF and septal E/Ea were significantly associated with GLS value at 6 months in multivariate analysis. At 6 months, there was a decrease in E/Ea (13±6 vs 17±9; p<0,001) and despite a significant decrease in pulmonary artery pressure, there was a significant alteration of right ventricle strain (–20.7±4.7 vs –23.2±5.8%; p < 0.001), in correlation with right atrium and tricuspid annulus dilatation.
K. Taamallah*, C. Chourabi, I. Hamdi, H. Mahfoudhi, H. Haouala Military hospital, Tunis, Tunisie. *Corresponding author: [email protected]
Conclusion LV presented a significant reverse remodelling after surgical or percutaneous AVR, especially in patients with altered GLS before procedure. This favourable LV remodelling contrast with unfavourable right cavities remodelling. (figure 1) The authors declare that they have no competing of interest.
© Elsevier Masson SAS. All rights reserved.
Left atrial strain assessed by tow-dimensional speckle tracking echocardiography in patients with severe mitral stenosis W. Fehri,
Introduction Mitral stenosis (MS) is a frequent valvopathy. IT results in significant overload of the left atrium (LA), exposing the patient to the risk of atrial arrhythmias with their hemodynamic and embolic consequences. The objective of our study is to demonstrate that this pressure overload alters the left atrial function. Methods This prospective study was carried out in the period from the 1st September 2015 to the 1st September 2016, on 36 patients with the diagnosis of an asymptomatic pure severe MS (mitral area ≤ 1.5 cm2) and 40 age and sex matched healthy subjects as a control group. LA volum and area, systolic pulmonary pressure and the study of atrial longitudinal strain by speckle tracking in the apical view (4 chamber and 2 chamber) was performed in the two groups, the peak atrial strain (characterizing LA reservoir function) and the time to peak (TAPLS) were measured for each subject. Results In the group of patients with MS: The average age was 48 years; a female predominance was noted (sex ratio 8/15). The LA area and the LA
253
Archives of Cardiovascular Diseases Supplements (2017) 9, 251-254
volume are significantly higher in the group MS (31,7±7,21 cm2 and 68,8±29,22ml/m2 BSA/ versus 16,5±0.7cm2 and 24,4ml±8,1/m2 BSA; P<0.001). Systolic pulmonary pressure was higher in the MS group (36 ± 7 mm Hg versus 25 ± 4 mm Hg; p<0.001). PALS in 4 chamber view was significantly lower in the group MS (12,59±5,23% versus 40,15± 8,95; p<0.001). TAPLS in 4 chamber view was more prolonged in patient with MS (380± 55,4 ms versus 312±49,25%; p<0.01 ). PALS in 2 chamber view was significantly lower in the group MS (13,28±5,07% versus 42,08± 9,43; p <0.001). TAPLS in 2 chamber view was more prolonged in patient with MS (377,56± 63,96 ms versus 311,88±44,7 ms; p<0.01). Conclusion we showed that, in patient with severe MS, the LA pressure overload alters the LA reservoir, exposing the patient to a risk of arrhythmia. The authors declare that they have no competing of interest.
33 Early detection of right ventricular dysfunction in patients with moderate mitral stenosis K. Taamallah*, C. Chourabi, H. Mahfoudhi, I. Hamdi, W. Fehri, H. Haouala Department of cardiology, military hospital, Tunis, Tunisie. *Corresponding author: [email protected] Introduction Moderate mitral stenosis (MS) is defined by a mitral area between 1.5 and 2 cm², usually does not cause clinical symptoms. The diagnosis of a right ventricular (RV) dysfunction is difficult before systemic signs of venous congestion occur.The aim of this study is to evaluate right ventricular function using 2D speckle tracking imaging in asymptomatic patients with a moderate MS. Methods In this prospective study, we enrolled 30 patients, in sinus rhythm with a moderate MS (mean of mitral area = 1.78 ± 0.11 cm²), free of symptoms and a group of 30, age and Sex matched, healthy subjects. All subjects included were free of diabetes, systemic hypertension, myocardial ischemia and chronic pulmonary pathology. RV Global longitudinal strain (RV-GLS) and RV free wall longitudinal train (RVLS-FW) were measured using speckle-tracking echocardiography. Other traditional parameters to evaluate RV function were also measured. Results RV fractional area change, RV Tei index and the tricuspid annular plane systolic excursion (TAPSE) are Comparable between the two groups. However, tricuspid annular peak systolic velocity is lower in the group of patients with moderate MS (12.6 ± 1,8cm / s vs 14.3 ± 1,9cm / s ; p <0.01). RV Global longitudinal strain (GLS) and the RV free wall longitudinal strain were decreased in patient with moderate MS (18,6±3,4% VS 23±2,8%) . This parameters were more increased in the subgroup with a mitral area of <1.7 cm² (RV GLS= 15,1±2,8%).
Conclusion Our study shows the presence of subclinical systolic dysfunction of the right ventricular, in patients with moderate MS, especially in the subgroup with a mitral area <1.7 cm². The authors declare that they have no competing of interest.
34 Left atrium volume index measurement in routine practice: does it independently impact survival of degenerative mitral valve disease? C. Antoine*1, G. Benfari1, S. Pislaru1, D. Messika-Zeitoun2, T. Le Tourneau3, J. Maalouf1, M. Enriquez-Sarano1 1 Mayo Clinic, Rochester, États-Unis d’Amérique, 2 Hôpital Bichat Claude Bernard, Université Paris VII, Paris, France, 3 Division des maladies cardiovasculaires, Université de Nantes, Nantes, France. *Corresponding author: [email protected] Introduction Pilot studies suggest that left atrium volume index (LAVI) enlargement negatively impacts survival of mitral regurgitation in sinus rhythm. But this prognostic impact is uncertain as definitive data are lacking in routine practice, with unified mitral etiology or in atrial fibrillation (AF). Thus European and US guidelines are discordant on use of LAVI for degenerative mitral valve disease (DMVD) management. We studied LAVI impact on survival among DMVD, with and without AF. Methods During 2003-2011, we included 5769 patients diagnosed in routine practice with isolated DMVD, with measured LAVI, regardless of the mitral regurgitation degree.Patients with more than moderate aortic valve disease, previous valvular surgery, or any specific myocardial or pericardial pathology other than related to the mitral regurgitation were excluded. Results Age was 63±16 years and LAVI 43±23ml/m², <40 ml/m² in 55%, 4059 ml/m² in 28% and ≥60 ml/m² in 17%. Larger LAVI at diagnosis was associated with excess mortality under medical treatment (hazard ratio: 1.22 [1.20-1.24] per 10 ml/m², p<0.0001) in univariate analysis. Association with excess mortality persisted accounting for mitral regurgitation severity, AF and with extensive adjustment (hazard ratio: 1.05 [1.02-1.08] per 10 ml/m², p<0.0001) as in all subgroups, particularly AF (hazard ration: 1.10 [1.06-1.13], p<0.0001) and sinus rhythm (hazard ratio:1.25 [1.21-1.28],p<0.0001). After mitral surgery, there was no residual association of LAVI with mortality. Conclusion In this large cohort of DMVD, LAVI measured in routine practice provides a strong independent prognosis value on mortality under medical treatment, regardless of AF presence. Thus LAVI is an essential component of the clinical decision-making process in DMVD (figure). The authors declare that they have no competing of interest.
Abstract 34 – Figure
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9, 251-254
Abstract 30 – Figure – Observed vs. expected mortality rates in women (a) and in men (b) with severe primary MR under medical treatment.
Abstract 31 – Figure 1 – GLS evolution 6 months after AVR regarding baseline GLS Methods The European Translink FP7 project prospectively included patients with aortic stenosis scheduled for surgical or percutaneous AVR. The present substudy included all patients enrolled in our center. Patients were separated in two groups regarding baseline left ventricle (LV) GLS value (normal ≤ or altered >– 16%). Cardiac remodelling and GLS were evaluated 6 months after AVR.
32
Results We included 200 patients (64% men, mean age 74±9 years) and 6 months follow up was completed in 127. LVEF at baseline was 62±10% and GLS –16.1±3.7%. Patients with baseline impaired GLS (n=85, 43%) were more often diabetics and obese, and had higher NT-proBNP levels. Cardiac cavities remodelling was more pronounced and LVEF was moderately decreased. These patients experienced a significant improvement in GLS at 6 months (– 15.3±3.8 VS –12.9±2.3%; p<0.0001), in contrast with patients with normal GLS at baseline (–18.7±1.6 VS –18.1±2.6%; p=0.07). Baseline LVEF and septal E/Ea were significantly associated with GLS value at 6 months in multivariate analysis. At 6 months, there was a decrease in E/Ea (13±6 vs 17±9; p<0,001) and despite a significant decrease in pulmonary artery pressure, there was a significant alteration of right ventricle strain (–20.7±4.7 vs –23.2±5.8%; p < 0.001), in correlation with right atrium and tricuspid annulus dilatation.
K. Taamallah*, C. Chourabi, I. Hamdi, H. Mahfoudhi, H. Haouala Military hospital, Tunis, Tunisie. *Corresponding author: [email protected]
Conclusion LV presented a significant reverse remodelling after surgical or percutaneous AVR, especially in patients with altered GLS before procedure. This favourable LV remodelling contrast with unfavourable right cavities remodelling. (figure 1) The authors declare that they have no competing of interest.
© Elsevier Masson SAS. All rights reserved.
Left atrial strain assessed by tow-dimensional speckle tracking echocardiography in patients with severe mitral stenosis W. Fehri,
Introduction Mitral stenosis (MS) is a frequent valvopathy. IT results in significant overload of the left atrium (LA), exposing the patient to the risk of atrial arrhythmias with their hemodynamic and embolic consequences. The objective of our study is to demonstrate that this pressure overload alters the left atrial function. Methods This prospective study was carried out in the period from the 1st September 2015 to the 1st September 2016, on 36 patients with the diagnosis of an asymptomatic pure severe MS (mitral area ≤ 1.5 cm2) and 40 age and sex matched healthy subjects as a control group. LA volum and area, systolic pulmonary pressure and the study of atrial longitudinal strain by speckle tracking in the apical view (4 chamber and 2 chamber) was performed in the two groups, the peak atrial strain (characterizing LA reservoir function) and the time to peak (TAPLS) were measured for each subject. Results In the group of patients with MS: The average age was 48 years; a female predominance was noted (sex ratio 8/15). The LA area and the LA
253
Archives of Cardiovascular Diseases Supplements (2017) 9, 251-254
volume are significantly higher in the group MS (31,7±7,21 cm2 and 68,8±29,22ml/m2 BSA/ versus 16,5±0.7cm2 and 24,4ml±8,1/m2 BSA; P<0.001). Systolic pulmonary pressure was higher in the MS group (36 ± 7 mm Hg versus 25 ± 4 mm Hg; p<0.001). PALS in 4 chamber view was significantly lower in the group MS (12,59±5,23% versus 40,15± 8,95; p<0.001). TAPLS in 4 chamber view was more prolonged in patient with MS (380± 55,4 ms versus 312±49,25%; p<0.01 ). PALS in 2 chamber view was significantly lower in the group MS (13,28±5,07% versus 42,08± 9,43; p <0.001). TAPLS in 2 chamber view was more prolonged in patient with MS (377,56± 63,96 ms versus 311,88±44,7 ms; p<0.01). Conclusion we showed that, in patient with severe MS, the LA pressure overload alters the LA reservoir, exposing the patient to a risk of arrhythmia. The authors declare that they have no competing of interest.
33 Early detection of right ventricular dysfunction in patients with moderate mitral stenosis K. Taamallah*, C. Chourabi, H. Mahfoudhi, I. Hamdi, W. Fehri, H. Haouala Department of cardiology, military hospital, Tunis, Tunisie. *Corresponding author: [email protected] Introduction Moderate mitral stenosis (MS) is defined by a mitral area between 1.5 and 2 cm², usually does not cause clinical symptoms. The diagnosis of a right ventricular (RV) dysfunction is difficult before systemic signs of venous congestion occur.The aim of this study is to evaluate right ventricular function using 2D speckle tracking imaging in asymptomatic patients with a moderate MS. Methods In this prospective study, we enrolled 30 patients, in sinus rhythm with a moderate MS (mean of mitral area = 1.78 ± 0.11 cm²), free of symptoms and a group of 30, age and Sex matched, healthy subjects. All subjects included were free of diabetes, systemic hypertension, myocardial ischemia and chronic pulmonary pathology. RV Global longitudinal strain (RV-GLS) and RV free wall longitudinal train (RVLS-FW) were measured using speckle-tracking echocardiography. Other traditional parameters to evaluate RV function were also measured. Results RV fractional area change, RV Tei index and the tricuspid annular plane systolic excursion (TAPSE) are Comparable between the two groups. However, tricuspid annular peak systolic velocity is lower in the group of patients with moderate MS (12.6 ± 1,8cm / s vs 14.3 ± 1,9cm / s ; p <0.01). RV Global longitudinal strain (GLS) and the RV free wall longitudinal strain were decreased in patient with moderate MS (18,6±3,4% VS 23±2,8%) . This parameters were more increased in the subgroup with a mitral area of <1.7 cm² (RV GLS= 15,1±2,8%).
Conclusion Our study shows the presence of subclinical systolic dysfunction of the right ventricular, in patients with moderate MS, especially in the subgroup with a mitral area <1.7 cm². The authors declare that they have no competing of interest.
34 Left atrium volume index measurement in routine practice: does it independently impact survival of degenerative mitral valve disease? C. Antoine*1, G. Benfari1, S. Pislaru1, D. Messika-Zeitoun2, T. Le Tourneau3, J. Maalouf1, M. Enriquez-Sarano1 1 Mayo Clinic, Rochester, États-Unis d’Amérique, 2 Hôpital Bichat Claude Bernard, Université Paris VII, Paris, France, 3 Division des maladies cardiovasculaires, Université de Nantes, Nantes, France. *Corresponding author: [email protected] Introduction Pilot studies suggest that left atrium volume index (LAVI) enlargement negatively impacts survival of mitral regurgitation in sinus rhythm. But this prognostic impact is uncertain as definitive data are lacking in routine practice, with unified mitral etiology or in atrial fibrillation (AF). Thus European and US guidelines are discordant on use of LAVI for degenerative mitral valve disease (DMVD) management. We studied LAVI impact on survival among DMVD, with and without AF. Methods During 2003-2011, we included 5769 patients diagnosed in routine practice with isolated DMVD, with measured LAVI, regardless of the mitral regurgitation degree.Patients with more than moderate aortic valve disease, previous valvular surgery, or any specific myocardial or pericardial pathology other than related to the mitral regurgitation were excluded. Results Age was 63±16 years and LAVI 43±23ml/m², <40 ml/m² in 55%, 4059 ml/m² in 28% and ≥60 ml/m² in 17%. Larger LAVI at diagnosis was associated with excess mortality under medical treatment (hazard ratio: 1.22 [1.20-1.24] per 10 ml/m², p<0.0001) in univariate analysis. Association with excess mortality persisted accounting for mitral regurgitation severity, AF and with extensive adjustment (hazard ratio: 1.05 [1.02-1.08] per 10 ml/m², p<0.0001) as in all subgroups, particularly AF (hazard ration: 1.10 [1.06-1.13], p<0.0001) and sinus rhythm (hazard ratio:1.25 [1.21-1.28],p<0.0001). After mitral surgery, there was no residual association of LAVI with mortality. Conclusion In this large cohort of DMVD, LAVI measured in routine practice provides a strong independent prognosis value on mortality under medical treatment, regardless of AF presence. Thus LAVI is an essential component of the clinical decision-making process in DMVD (figure). The authors declare that they have no competing of interest.
Abstract 34 – Figure
© Elsevier Masson SAS. All rights reserved.