Abstract
The relationship of mitral annular (MA) kinetics to left ventricular (LV) and left atrial (LA) function before and after mitral valve (MV) repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, and LA and LV diastolic function post MV repair. Three-dimensional analyses of mitral annular motion, LA function, and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR) patients at baseline and 1-year post MV repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging. All had normal LV ejection fraction (EF) at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early diastolic filling rate, E/A ratio, and early diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate. MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function, and LV diastolic strain rates are still impaired 1 year post MV repair. Long-term effects of these impairments should be prospectively evaluated.
Highlights
Degenerative mitral regurgitation (MR), usually related to mitral valve (MV) prolapse, is responsible for most cases of isolated MR in the US [1], causing a major public health burden
We extend our previous work [6] and utilized comprehensive cardiac magnetic resonance imaging with tagging and 3-dimensional (3D) analysis to evaluate mitral annular motion, and left atrium (LA) and left ventricular (LV) function
Study Population The same study population was used in the current investigation as our previous study [6], consisting of 51 control subjects, 35 patients with moderate to severe MR secondary to degenerative MV disease who were referred for corrective MV repair
Summary
Degenerative mitral regurgitation (MR), usually related to mitral valve (MV) prolapse, is responsible for most cases of isolated MR in the US [1], causing a major public health burden. The natural history of MR is progressive left ventricular (LV) dysfunction and adverse LV remodeling, eventually leading to heart failure. There is no effective medical therapy for isolated MR, and surgery is recommended in patients with severe MR and symptoms or evidence of progressive LV dysfunction [2, 3]. We have previously demonstrated that in isolated MR with normal LVEF, despite adherence to the guideline recommendations at the time of operation, there is impaired LV systolic function and persistent spherical remodeling 1-year post surgery [4,5,6]. MA is a saddle-shaped structure that is anatomically and functionally contiguous with both left atrium (LA) and LV.[7,8,9] It demonstrates complex motion during the cardiac cycle that is mediated predominantly due to contractility of LA and LV [10]
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