New Technique in Assessment of Heart Chambers Remodeling in Acquired Mitral Valve Defects.

Leo Bokeria,Tatiana Kosareva,Vladimir Makarenko

doi:10.3390/jcdd7020014

Abstract

Objective: Analysis and presentation of the capabilities of the new ultrasound technique —the index of volume remodeling (IRV), which allows comprehensive assessing of pathological remodeling of the heart as an integrated functional anatomical system. Materials and methods: For this study 316 patients with acquired mitral valve disease (MVD) were examined prior to and following mitral valve replacement with bileaflet, disc-, and bioprostheses. Key parameters of the heart were measured in classical echocardiographic projections (end systolic area, end-diastolic area, end systolic volume, and end diastolic volume of ventricles, ventricular ejection fraction, atrial volume, and the ratio of ventricular to atrial volumes). The patients were examined 1–2 days prior to and following the surgery—before discharge, 6 months later, 1 year later, and then annually within next 5 years. The examination data were collected in one- and two-dimensional modes by using Philips EpiQ-7, iE33, HDI, Siemens Acuson, and HP Sonos 2500 diagnostic ultrasound machines equipped with 2.5 and 3.5 MHz transthoracic sensors. Results: A comprehensive study of structural geometric remodeling parameters of heart cavities in the context of acquired MVD allowed identifying new patterns in changes of the heart chambers geometry. These changes are reflected in the IRV, a digital indicator of the severity of cardiac pathological remodeling. Analysis of the dynamics of post-operative vs. pre-operative IRV-based remodeling data also showed that the index is highly sensible to the hemodynamic features of through-flows in various designs of prostheses. The IRV has a pronounced prognostic power and allows predicting the long-term outcome of surgical treatment with an accuracy of 82.35%. Conclusions: The IRV predictive accuracy formed the basis of the original classification of types of cardiac remodeling, which can assist both in determining the optimal timing for surgery, and in conjunction with other clinical diagnostic data, in predicting the long-term outcome of heart geometry restoration depending on the type of surgical correction. The IRV can be used in evaluation of the heart geometry for any cardiac pathology. It makes the approach to the analysis of pathological remodeling of the heart understandable, consistent, and universal, and also opens up opportunities for further expanding the diagnostic capabilities of radiology in cardiac surgery at all stages of the diagnostic process.

Highlights

Acquired heart defects represent a significant social problem as they affect people of socially active age and can lead to permanent disability, and to death of patients, especially in case of ill-timed and inadequate treatment.While conservative treatment methods have clear clinical performance criteria, the timing of surgical correction has no fully defined criteria and is left to the discretion of the treating cardiologist or a patient’s decision [1,2,3].Presently the flags for determining the timing of surgical intervention are heart rhythm disturbances and clinical manifestations, which do not always reflect the severity of intracardiac hemodynamic impairment
Analysis of the IRV in 316 patients with organic mitral valve disease (MVD) showed that only 3.5% of patients have normal ratio of the heart cavities volumes, a small number that can be neglected to preserve the structure of our research
Our research offers a new ultrasound technique that can be used for a comprehensive assessment of the geometry of the heart as an integrated functional anatomical system

Summary

Introduction

Acquired heart defects represent a significant social problem as they affect people of socially active age and can lead to permanent disability, and to death of patients, especially in case of ill-timed and inadequate treatment.While conservative treatment methods have clear clinical performance criteria, the timing of surgical correction has no fully defined criteria and is left to the discretion of the treating cardiologist or a patient’s decision [1,2,3].Presently the flags for determining the timing of surgical intervention are heart rhythm disturbances and clinical manifestations, which do not always reflect the severity of intracardiac hemodynamic impairment. Acquired heart defects represent a significant social problem as they affect people of socially active age and can lead to permanent disability, and to death of patients, especially in case of ill-timed and inadequate treatment. While conservative treatment methods have clear clinical performance criteria, the timing of surgical correction has no fully defined criteria and is left to the discretion of the treating cardiologist or a patient’s decision [1,2,3]. The flags for determining the timing of surgical intervention are heart rhythm disturbances and clinical manifestations, which do not always reflect the severity of intracardiac hemodynamic impairment. Often patients do not feel rhythm disturbances or do not pay due attention to them. Arrhythmia in such case is diagnosed accidentally. Often patients notice heart failure symptoms only when they begin to significantly limit their social activity

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Conclusion