Diastolic Mitral Regurgitation Research Articles

Abstract 13419: Transient Coronary Artery to Left Ventricular Fistula With Diastolic Mitral Regurgitation

Introduction: A fistula from a coronary artery to the cardiac chamber is incidentally found in 0.08% to 0.3% of patients undergoing coronary angiography. Case Presentation: A 73-year-old woman with hypertension, diabetes mellitus, chronic renal failure, and nephrosis visited our department due to dyspnea. The patient’s physical examination revealed a blood pressure of 191/109 mmHg and a pulse rate of 77 beats per min. The blood sampling results revealed a plasma brain natriuretic peptide level of 2,001 pg/mL. A 12-lead electrocardiogram showed poor R wave progression in leads V1 to V4. Chest radiography revealed left pleural effusion. Parasternal transthoracic echocardiography showed left ventricular hypertrophy. Left ventricular (LV) ejection fraction was 41%. A pulsed-wave Doppler echocardiography at the mitral inflow showed diastolic mitral regurgitation and a fusion of E and A waves. An unusual myocardial flow was noted in the apical myocardium. It was directed toward the apical surface during systole (Fig. 1a), and directed toward the LV lumen during diastole (Fig. 1b), suggesting coronary artery to LV fistula through sinusoid. Global strain obtained from apical long axis imaging showed myocardial shortening continued to diastole, suggesting post-systolic shortening (PSS). After treatment for hypertension, both of myocardial flow and diastolic MR disappeared. A longitudinal global strain imaging revealed disappearance of PSS. Conclusion: This is a rare case of diastolic MR due to PSS at the fistula from the coronary artery to the left ventricle.

PO-01-060 HEART FAILURE DUE TO DIASTOLIC MITRAL REGURGITATION AND BRADYCARDIA SECONDARY TO BLOCKED BIGEMINAL PREMATURE ATRIAL CONTRACTIONS AFTER DEVICE CLOSURE OF PATENT FORAMEN OVALE

Diastolic mitral regurgitation (DMR) may occur due to an increased left ventricular (LV) cavity pressure compared to the left atrial (LA) pressure. This may occur with bradycardia when diastolic filling time is increased. In our case, the patient was found to have blocked bigeminal premature atrial contractions (PACs) causing bradycardia leading to diastolic mitral regurgitation. N/A N/A A 58-year-old woman presented with one week history of shortness of breath, paroxysmal nocturnal dyspnea, lower extremity edema, and weight gain. Past medical history was remarkable for transient ischemic attack and closure of patent foramen ovale with 30-mm Gore device. Examination was remarkable for bradycardia, elevated JVP and peripheral edema. Electrocardiogram showed bradycardia secondary to blocked bigeminal premature atrial complexes (PAC) [Fig A]. Transthoracic echocardiogram demonstrated diastolic mitral valve regurgitation [Fig B]. Cardiac catheterization showed normal coronary arteries. She was treated with intravenous furosemide for volume management. Bradycardia was paradoxically treated using nadolol 20 mg daily for suppression of PACs after which the patient’s symptoms were stabilized. DMR is usually seen in complete heart block due to reversal in atrioventricular pressure gradients. Interestingly, in our case, non-conducted PACs which caused significant bradycardia were responsible for DMR. PAC morphology was consistent with septal origin. We propose that the likely etiology of septal PACs is the impingement of septal occluder device on the non-coronary sinus and retro-aortic atrial septum.

Abstract 11477: Assessing New Onset of Atrial Arrhythmia in Patients Undergoing Alcohol Septal Ablation for Hypertrophic Obstructive Cardiomyopathy

Introduction: Alcohol septal ablation (ASA) is an effective percutaneous procedure used to treat refractory hypertrophic obstructive cardiomyopathy (HOCM). ASA relieves left ventricular outflow tract (LVOT) obstruction by creating a targeted infarction in the septal muscle. Diastolic dysfunction and mitral regurgitation are responsible for increased left atrial pressure which contributes to left atrial ectopy. We seek to assess the incidence of atrial arrhythmias post-ASA and identify predictors to risk stratify these patients. Methods: Using a patient database maintained internally, 144 consecutive patients who underwent ASA for HOCM between March 2017 and February of 2022 at MUSC were retrospectively reviewed. Patients were selected based on the need for cardiac event monitoring after ASA. Patients were retrospectively analyzed for a previous history of atrial fibrillation (AF) as well as a new onset of AF after ASA. SPSS statistics was used for statistical analysis. Results: A total of 31 patients met final inclusion criteria. During the monitored time, seven patients (22.58%) developed a new onset of AF after ASA. Patients who developed AF post-ASA were found to have a statistically higher left atrial end-systolic volume index (LAESVi, mL/m 2 ) and left ventricular end-diastolic pressure (LVEDP, mmHg) (59.96 ± 8.93, 34.33 ± 11.54) when compared to those who did not develop AF (41.13 ± 13.93, 23.33 ± 9.06 (p=0.0003, p=0.0331)). Conclusions: In this high-risk proportion of patients who required cardiac monitoring post-ASA, there is a higher-than-expected risk for new onset of AF. The left atrial size and left ventricular filling pressures before ablation were the only significant predictors for development of atrial arrhythmias after ASA. Longer-term evaluation will be able to address if the expected reduction in atrial size and LVOT gradient after ASA will reduce the overall long-term burden of atrial arrhythmias.

Abstract 11219: Female Patients Attending Female Cardiologist-Led Heart Clinic in Iraq: Clinical Landscape and Echocardiographic Data

Introduction: In Iraq, traditional and tribal rules prevent many women from having access to healthcare unless being managed exclusively by female doctors. So, lack of female cardiologists (FC) in Iraq deprived many women from proper cardiovascular care.Considering the absent Women′s Heart Clinics in Iraq and lack of data on female cardiac patients,we sought to provide data regarding demographic and echocardiographic characteristics of women attending a female cardiologist-led heart clinic (FC-LHC) in a first report from Iraq Methods: Women who attended a FC-LHC were included, clinical and echocardiographic characteristics were recorded. Results: n=213, mean age (46.5±16.6)year.Hypertension (HT) and dyslipidemia were most reported risk factors.History of gestational HT was most common sex-specific risk factor (figA).Women′s comorbidities differs with their social status as HT, DM, IHD and dyslipidemia were highest in widowed women (91.3%, 43.5%, 21.7% and 39.1% respectively). Consuming fast food≥4/week was highest in divorced (33.3%) and single women (23.1%). OCP was used by 5.2% of women; in general and 10.3% of married women at reproductive age; in particular. Prevalence of DM,IHD and LV dysfunction differs according to women′s education (figB). Palpitation (46.5%) and dyspnoea (30%) were most common presentations. Cardio-Obstetric and Cardio-Oncology services were offered in 5.2% and 5.6% respectively (figC). LV diastolic dysfunction and mitral regurgitation were most common echocardiographic abnormalities (figD). Conclusion: Younger women<65 years were more frequently attending FC-LHC.Prior history of gestational HT was the commonest sex-specific cardiovascular risk factor. Increasing diversity in cardiology workforce and establishing Women′s Heart Clinics that include FC are crucial in Iraq to promote focused cardiovascular care and education and to provide data for sex-specific research in cardiovascular management and outcomes

Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy

BackgroundB-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).AimTo assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.MethodsWe enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e’; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.ResultsLUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e’ (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e’ (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.ConclusionsTwo-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.

Intraoperative transesophageal echocardiography reveals diastolic mitral regurgitation caused by an aortic regurgitation jet.

Intraoperative transesophageal echocardiography reveals diastolic mitral regurgitation caused by an aortic regurgitation jet.

Echocardiographic manifestations in patients on renal replacement therapy and renal transplant recipients

Background: Chronic kidney disease (CKD) patients have 20–30 times greater risk of cardiovascular morbidity and mortality. Echocardiography is quintessential in cardiovascular evaluation and monitoring in CKD patients. This study was designed to determine the echocardiographic manifestations in patients on renal replacement therapy (RRT) and recipients of renal transplantation. Materials and Methods: An observational cross-sectional study was undertaken in a tertiary care hospital. All CKD patients on RRT or post renal transplant were included. Patients with known cardiac disease, malignancy were excluded. Demographic details, thorough history, physical examination and 2D echocardiography were performed for the patients. Results: Of the 51 patients, 60% were on dialysis and remaining were post renal transplant recipients. The mean age of study population was 44.16±13.66 years, with 64.7% males. 47% of patients were of age group of 41 years to 60 years. The most common etiology of CKD was hypertension in 16 (31.4%) followed by diabetes in 11 (21.6%). Only 8 patients (15.7%) had normal echocardiograms. LVH (80.4%) was most common abnormality, followed by diastolic dysfunction (74.5%), systolic dysfunction (13.7%), mitral regurgitation (13.7%) and pericardial effusion (5.8%). Around 95.2% had concentric hypertrophy. Diastolic dysfunction was observed in 90.2% and 80.9% of cases with LVH and hypertension respectively and was significantly associated with both (p=0.001, p=0.003 respectively). Conclusions: Left ventricular hypertrophy was the most common abnormality in CKD patients and renal transplant recipients. Diastolic function was affected in majority of patients. Early identification of cardiac abnormalities by echocardiography prior to manifestation of cardiac complications may result in better prognosis for this patient population.

A Rare Case of Giant Unruptured Sinus of Valsalva Aneurysm

Sinus of Valsalva aneurysm is a rare congenital disorder that usually presents with rupture of the aneurysm into adjacent cardiac structures. It usually arises from the right sinus of Valsalva which ruptures into the right ventricle or right atrium (RA). Aneurysms may also arise from the noncoronary cusp that rupture into RA. Rarely, an unruptured aneurysm may compress or dissect into the adjacent structures and produce obstruction to either left or right ventricular outflow or produce conduction blocks. It may also intrude upon valves affecting valvular function. Here is a case of an unruptured giant aneurysm arising from the right sinus of Valsalva burrowing into the interventricular septum (IVS) causing conduction defect in the form of left bundle branch block with first degree atrioventricular block. Through IVS, it protruded into the left ventricular (LV) outflow tract (LVOT) giving rise to a cystic appearance causing mild LVOT obstruction and mild-to-moderate aortic regurgitation. The aneurysm also affected mitral valve function causing severe mitral regurgitation (MR) including characteristic diastolic MR due to prolonged PR interval. There was no regional wall motion abnormality indicating the absence of coronary arterial obstruction by the aneurysm. Left atrial and LV dilatation was present along with LV systolic dysfunction. Pulmonary arterial systolic pressure was approximately 48 mmHg as calculated from tricuspid regurgitation (TR) gradient. Like MR, TR also showed diastolic TR.

Atrial fibrillation of new onset during acute illness: prevalence of, and risk factors for, persistence after hospital discharge.

BackgroundAtrial fibrillation (AF) of new onset during acute illness (AFNOAI) has a variable incidence of 1%–44% in hospitalized patients. This study assesses the risk factors for persistence of AFNOAI in the 5 years after hospital discharge for critically ill patients.MethodsThis was a retrospective cohort study. All patients ≥18 years old admitted to the medical intensive care unit (MICU) of a tertiary care hospital from January 1, 2012, to October 31, 2015, were screened. Those designated with AF for the first time during the hospital admission were included. Risk factors for persistent AFNOAI were assessed using a Cox’s proportional hazards model. ResultsTwo-hundred and fifty-one (1.8%) of 13,983 unique MICU admissions had AFNOAI. After exclusions, 108 patients remained. Forty-one patients (38%) had persistence of AFNOAI. Age (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.01–1.08), hyperlipidemia (HR, 2.27; 95% CI, 1.02–5.05) and immunosuppression (HR, 2.29; 95% CI, 1.02–5.16) were associated with AFNOAI persistence. Diastolic dysfunction (HR, 1.46; 95% CI, 0.71–3.00) and mitral regurgitation (HR, 2.00; 95% CI, 0.91–4.37) also showed a trend towards association with AFNOAI persistence. ConclusionsOur study showed that AFNOAI has a high rate of persistence after discharge and that certain comorbid and cardiac factors may increase the risk of persistence. Anticoagulation should be considered, based on a patient’s individual AFNOAI persistence risk.

Pacing therapy for atrioventricular dromotropathy: a combined computational-experimental-clinical study.

AimsInvestigate haemodynamic effects, and their mechanisms, of restoring atrioventricular (AV)-coupling using pacemaker therapy in normal and failing hearts in a combined computational–experimental–clinical study.Methods and resultsComputer simulations were performed in the CircAdapt model of the normal and failing human heart and circulation. Experiments were performed in a porcine model of AV dromotropathy. In a proof-of-principle clinical study, left ventricular (LV) pressure and volume were measured in 22 heart failure (HF) patients (LV ejection fraction <35%) with prolonged PR interval (>230 ms) and narrow or non-left bundle branch block QRS complex. Computer simulations and animal studies in normal hearts showed that restoring of AV-coupling with unchanged ventricular activation sequence significantly increased LV filling, mean arterial pressure, and cardiac output by 10–15%. In computer simulations of failing hearts and in HF patients, reducing PR interval by biventricular (BiV) pacing (patients: from 300 ± 61 to 137 ± 30 ms) resulted in significant increases in LV stroke volume and stroke work (patients: 34 ± 40% and 26 ± 31%, respectively). However, worsening of ventricular dyssynchrony by using right ventricular (RV) pacing abrogated the benefit of restoring AV-coupling. In model simulations, animals and patients, the increase of LV filling and associated improvement of LV pump function coincided with both larger mitral inflow (E- and A-wave area) and reduction of diastolic mitral regurgitation.ConclusionRestoration of AV-coupling by BiV pacing in normal and failing hearts with prolonged AV conduction leads to considerable haemodynamic improvement. These results indicate that BiV or physiological pacing, but not RV pacing, may improve cardiac function in patients with HF and prolonged PR interval.

Early diastolic mitral regurgitation in left ventricular aneurysm.

Diastolic mitral regurgitation is a type of functional mitral regurgitation that develops via a reversal of the left atrioventricular pressure gradient during diastole. This study aimed to explore the mechanism underlying early diastolic mitral regurgitation (EDMR) in patients with left ventricular (LV) aneurysms after anterior myocardial infarction (AMI) by assessing the intraventricular pressure difference using vector flow mapping. We enrolled 23 consecutive patients with LV aneurysms (with and without EDMR) and 15 healthy men as controls. In the control group, LV suction began from the apex during early diastole. In contrast, the blood that pooled in the apical aneurysm during systole generated a relatively higher pressure at the apex than at the basal LV during early diastole; consequently, the pressure reversal phenomenon occurred in the LV. Compared to the EDMR- group, the EDMR + group (n = 7) exhibited a significantly higher diastolic time ratio ([time from the second heart sound to the pressure inversion point]/[total diastolic time]) (P < 0.001). The diastolic time ratio was significantly correlated with log BNP, but not with E/A, E/E', or the left atrial expansion index. In conclusion, EDMR in LV aneurysm may be due to a prolonged diastolic time ratio leading to prolonged pressure inversion in the LV during early diastole.

Heart Failure Due to High-Degree Atrioventricular Block: How Frequent Is It and What Is the Cause?

The causes of heart failure (HF) during high-grade atrioventricular block (AVB) are poorly understood. This study assessed the mechanisms of HF in patients with AVB. We studied patients presenting (between 2012 and 2016) with high-grade AVB not related to acute myocardial infarction. Patients with preexisting significant valvular heart disease were excluded. All patients underwent comprehensive echocardiographic evaluation during AVB, before pacemaker implantation. The diagnosis of HF was based on the Framingham criteria. A total of 122 patients were included in the study, 50% male, average age 76 ± 13 years. Twenty-eight patients (23%) with AVB presented with HF. Univariate correlates associated with HF were decrease in cardiac output (CO) (odds ratio [OR] 0.68 [95% confidence interval 0.49-0.9] per L/min; P=0.007), measures of impaired left ventricular (LV) compliance, and increase in diastolic mitral regurgitation (MR) volume (OR 1.04 [1.01-1.07] per cc; P=0.0016). Ventricular rate during AVB and LV ejection fraction were not significantly associated with the presence of HF. By multivariate nominal logistic analysis, the best model associated with HF included diastolic MR volume (OR 1.04 [1.001-1.09]; P=0.02), A-wave deceleration time (OR 0.96 [0.94-0.9]; P=0.001), and CO (OR 0.92 [0.4-1.00]; P=0.005) (χ2=30.6; area under the receiver operating characteristic curve=0.84; P < 0.0001 for the entire model). In the setting of high-degree AVB, clinical HF occurrence correlates with impaired LV compliance and diastolic MR volume, but not with heart rate or LV ejection fraction. The cardiac performance of patients with poor LV compliance and high-volume diastolic MR may show maladjustment to slow heart rates, manifesting as low CO and HF.

Correlation between Transient Hypotension and Exclusively Exercise-induced Symptoms of Two-to-One Atrioventricular Block

A 62-year-old woman with activity-dependent two-to-one atrioventricular block (2:1AVB) and a normal left ventricular ejection fraction was referred to our department for the evaluation of exclusively exercise-induced marked symptoms. The treadmill test helped establish a clear correlation between 2:1AVB and symptoms. The test results demonstrated that exercise-induced marked symptoms were attributed to abrupt transient hypotension combined with relative bradycardia, probably due to increased diastolic mitral and tricuspid regurgitation because of 2:1AVB during moderate-to-heavy exercise. After pacemaker implantation for 2:1AVB, the symptoms and transient hypotension disappeared, and her exercise capacity improved.

Clinical and echocardiographic predictors of decompensation in acute severe aortic regurgitation due to infective endocarditis.

Patients with acute severe aortic regurgitation (AR) due to infective endocarditis can progress rapidly from the hemodynamically stable patient to pulmonary edema and cardiogenic shock. We sought to identify patients at risk of decompensation where emergent surgery should be undertaken. We identified 90 patients with acute severe AR from the echocardiography laboratory database. Baseline clinical, hemodynamic (heart rate (HR) and blood pressure (BP)), and echocardiographic data including mitral filling, premature mitral valve closure (PMVC), and diastolic mitral regurgitation (DMR) were identified. The primary endpoint was subsequent development of pulmonary edema or severe hemodynamic instability. Patients who met the primary endpoint had a higher HR (98.5bpm vs 80.5bpm), lower diastolic BP (54mmHg vs 61.5mmHg), higher mitral E-wave velocity (113cm/s vs 83cm/s), higher E/e' ratio (12.4 vs 8), higher proportion of DMR (27.8% vs 7.4%), and PMVC (25% vs 9.3%) than patients who did not meet the endpoint. The proportion of patients with the primary endpoint increased as HR increased ((≤81bpm) 3/30 (10%), (81-94bpm) 11/31 (35.5%), (≥94bpm) 22/29 (75.9%), P<.0001) and as the diastolic BP reduced ((≤54mmHg) 19/31 (61.3%), (54-63mmHg) 12/31 (38.7%), (≥63mmHg) 5/28 (17.9%), P=.003). Independent predictors were a higher HR (OR 1.08 (95% CI 1.04-1.13) P=.0003) and DMR (OR 4.71 (95% CI 1.23-18.09), P=.02). Decompensation in acute severe AR is common. Independent predictors of decompensation are increasing HR(≥94bpm) and the presence of DMR. Those with these adverse markers should be considered for emergent surgery.

Diastolic mitral regurgitation in a patient with 2:1 atrioventricular block

For diastolic mitral regurgitation to occur, diastolic left ventricular pressure must exceed the left atrial pressure. In the case presented here, this was due to isolated atrial contraction, not followed by a ventricular systole.

Value of a comprehensive exercise echocardiography assessment for patients with hypertrophic cardiomyopathy

Abstract Background Exercise echocardiography (ExE) may assess left ventricular (LV) systolic and diastolic function, LV outflow tract (LVOT) obstruction and mitral regurgitation (MR). We aimed to assess the feasibility and prognostic value of the assessment of all these issues during exercise in patients with hypertrophic cardiomyopathy (HCM). Methods LV systolic and diastolic function, LVOT gradients, and MR were evaluated during ExE in 285 patients with HCM (age 60±14 years, 168 men) and preserved LVEF (≥50%). Recordings were obtained at rest and peak exercise for regional/global LV systolic function and at rest and within 1.5 min after exercise for the rest of assessments: LVOT gradients, MR and ratio of early LV inflow velocity to early tissue Doppler septal annulus velocity (E/e'). Results Feasibility was 100%, 97%, 98% and 98% for LV systolic function, E/e', LVOT gradients, and MR assessments at exercise, respectively. Thirty-seven patients (13%) had LVOT obstruction at rest, and 76 (27%) developed exercise-induced LVOT obstruction. Mean resting LVEF was 63±3%. New wall motion abnormalities (WMAs) were detected in 38 patients (13%). E/e'&amp;gt;15 was observed in 108 patients at rest (38%) and in 119 at exercise (42%). Corresponding figures for significant MR (moderate or severe) were 20 (7%) and 17 (6%). During follow-up of 3.9±2.5 years, 21 patients had a hard event (cardiac death or transplantation, appropriate discharge of a defibrillator, stroke, myocardial infarction, hospitalization for heart failure), 33 a combined event (hard plus new atrial fibrillation or syncope), and 53 a combined event plus any interventionism. After adjustment, LV wall thickness, resting LVEF, maximal workload in Metabolic Equivalents (METs), and E/e' post-exercise resulted independent predictors of hard events (HR=1.45, 95% CI: 1.21–1.74, p&amp;lt;0.001; HR=0.80, CI: 0.71–0.89, p&amp;lt;0.001; HR=0.73, 95% CI: 0.62–0.86, p&amp;lt;0.001; HR=1.08, 95% CI: 1.02–1.14, p&amp;lt;0.009, respectively). Independent predictors of combined events included also LV wall thickness, resting LVEF, and METs, along with therapy with beta-blockers at the time of ExE (HR=1.29, 95% CI: 1.12–1.50, p=0.001; HR=0.89, CI: 0.81–0.97, p=0.012; HR=0.83, 95% CI: 0.74–0.93, p=0.001; HR=2.51, 95% CI: 1.20–5.25, p=0.015), whereas the model for combined events+any interventionism consisted of beta-blockers, LV wall thickness, LA dimension, METs and new WMAs. (HR=2.15, 95% CI: 1.20–3.86, p=0.01; HR=1.17, 95% CI: 1.03–1.32, p=0.02; HR=1.07, CI: 1.02–1.11, p=0.005; HR=0.90, 95% CI: 0.82–0.98, p=0.01; HR=2.33, 95% CI: 1.17–4.63, p=0.016) Conclusions A comprehensive assessment during ExE is feasible for patients with HCM and provides significant incremental prognostic information Funding Acknowledgement Type of funding source: None

Abnormal mitral flow, what is the cause?

Diastolic mitral regurgitation is a unique Doppler finding that can be missed if special attention is not paid to it. There are a few causes of such abnormal flow, ranging from a conduction abnormality to abnormal valvular and left ventricle function. Failure to recognize it might lead to unnecessary investigations and delay the primary diagnosis. We are presenting a teaching case and discuss the associated pathology.

Mechanisms, features, and significance of diastolic mitral regurgitation: a case series.

BackgroundDiastolic mitral regurgitation (DMR) is a type of functional mitral regurgitation. Its occurrence in the diastolic phase of cardiac cycle renders DMR an easily ignored entity. Confusing it with systolic mitral regurgitation occasionally happens. The reversal of left atrioventricular pressure gradient during diastole and the incomplete closure of mitral valve are the essential conditions for DMR. Diastolic mitral regurgitation develops under various situations, where the mechanisms of diastolic reversal of left atrioventricular pressure gradient differ.Case summaryPatient 1 was a 50-year-old man diagnosed with 2:1 second-degree atrioventricular block (AVB). Patient 2 was a 70-year-old man diagnosed with first-degree AVB. Patient 3 was a 66-year-old man diagnosed with atrial fibrillation with long intermission and occasional atrial flutter with unequal conduction. Patient 4 was a 54-year-old woman diagnosed with dilated cardiomyopathy with complete left bundle branch block. Patient 5 was a 36-year-old man diagnosed with severe acute aortic regurgitation secondary to subacute bacterial endocarditis.DiscussionAlthough the degree of DMR is relatively mild, its appearance generally prompts further clinical considerations. The appreciation of DMR has an incremental value for diagnosing and evaluating the underlying cardiovascular disease.

Intraoperative Assessment and Significance of Diastolic Mitral Regurgitation by Transesophageal Echocardiography.

Intraoperative Assessment and Significance of Diastolic Mitral Regurgitation by Transesophageal Echocardiography.

Left Ventricular Dysfunction: The Perspective of Echocardiography in Ghana

Introduction: Ghana is one of the fastest growing economies in sub-Saharan Africa which is expected to undergo a significant epidemiologic transition because of industrialisation and economic development. Having transitioned from low to middle income status recently, this study investigated the epidemiology of left ventricular dysfunction (LVD) in patients who were referred for echocardiography. Material and Methods: We conducted a retrospective cross-sectional study on an out-patient population who were referred to the Precise Specialist Clinic in Kumasi, Ghana for echocardiography, from January 2016 to December 2018. Descriptive statistical analyses were performed and the results summarised in the proportions, tables and pie charts. Categorical variables and proportions were compared using Fisher’s exact test and test of proportions respectively. P-value Results: The results show that 61% of the out-patient population referred for echocardiography between 2016 and 2018 had LVD at a mean age of 59 years. In this LVD population, Heart Failure with preserved ejection fraction (HFpEF) and Heart Failure with reduced ejection fraction (HFrEF) accounted for 73% and 27% respectively. The majority of patients with HFrEF also had left ventricular diastolic dysfunction, mitral regurgitation and tricuspid regurgitation.Conclusion: This study shows that, HFpEF was seen in over 70% of patients with LVD, and it occurred at a relatively younger age. Efforts should be made for prevention, early detection and control of conditions such as hypertension, diabetes and obesity which have been shown to be associated with HFpEF.