Diastolic Mitral Valve Research Articles

Multi-modality non-invasive assessment of cardiopulmonary haemodynamics using cardiovascular magnetic resonance pulmonary transit time and echocardiography

Abstract Introduction Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction and mitral valve regurgitation. Methods We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant diastolic dysfunction (DD) and mitral valve regurgitation (MVR) were defined as exceeding grade I (impaired relaxation, mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula. Results Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61 to 0.85; p=0.001) for PTT and 0.81 (CI 0.71 to 0.89; p<0.001) for nPTT. For MVR the diagnostic performance amounted to an AUC of 0.80 (CI 0.68 to 0.92; p<0.001) for PTT and 0.78 (CI 0.65 to 0.90; p<0.001) for nPTT. PTT values < 8 s rule-out presence of DD and MVR with a probability of 70% (Negative predictive value 78%). Conclusion CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR - as assessed by echocardiography - unlikely. Pulmonary Transit Time Pulmonary Transit Time

Transthoracic cardiac ultrasonic shear wave elastography for detecting myocardial stiffness in healthy and hypertrophic cardiomyopathy individuals

Objective: To explore the feasibility of transthoracic cardiac shear wave elastography (SWE) for non-invasive quantitative measurement of myocardial stiffness in healthy volunteers (HV) and hypertrophic cardiomyopathy (HCM) patients, and analyze the relationship between myocardial shear wave velocity (SWV) and left ventricular diastolic function. Methods: A total of 16 HV who underwent health check-ups and 5 HCM patients who visited the Cardiology Outpatient Clinic at Fujian Medical University Affiliated Union Hospital from September 2022 to October 2023 were prospectively recruited. The SWE technique was used to measure SWV of the basal segment of the interventricular septum, including left ventricular long-axis myocardial shear wave velocity (LA-SWV) and short-axis myocardial shear wave velocity (SA-SWV). The intraclass correlation coefficient (ICC) was employed to evaluate the intra-observer and inter-observer consistency of SWV measurements. Spearman's correlation analysis was performed to evaluate the correlation between baseline characteristics, echocardiography parameters and SWV. Quantitative data were expressed as median (interquartile range) [M (Q1, Q3)]. Results: The HV group had the age of 34.5 (24.0, 51.0) years, including 8 males (50%); the HCM group had the age of 34.0 (27.0, 46.0) years, including 3 males (60%). The intra-observer and inter-observer ICC (95%CI) for LA-SWV measurements were 0.806 (0.592-0.907) and 0.785 (0.471-0.949), respectively, indicating high consistency; the intra-observer and inter-observer ICC (95%CI) for SA-SWV measurements were 0.746 (0.359-0.862) and 0.602 (0.245-0.834), indicating moderate consistency. LA-SWV [1.74 (1.65, 1.77) vs 1.25 (1.22, 1.33) m/s, P<0.001] and SA-SWV [1.98 (1.96, 2.15) vs 1.52(1.46, 1.55) m/s, P<0.001] were significantly higher in HCM group than those in HV group. There was no significant correlation between SWV and gender, age or body mass index (all P>0.05). In the left ventricular long-axis view, interventricular septal end-diastolic thickness (IVSDT) (r=0.749, P<0.001), early diastolic mitral valve flow velocity/early diastolic mitral annular peak motion velocity (E/e') (r=0.669, P<0.001), and left ventricular mass index (LVMI) (r=0.679, P<0.001) were positively correlated with LA-SWV, while e' (r=-0.545, P<0.001) and late diastolic mitral annular peak motion velocity (r=-0.489, P=0.021) were negatively correlated with LA-SWV. In the left ventricular short-axis view, IVSDT (r=0.784, P<0.001), E/e' (r=0.657, P<0.001), and LVMI (r=0.660, P<0.001) were positively correlated with SA-SWV, while e' was negatively correlated with SA-SWV (r=-0.658, P<0.001). Conclusions: The use of SWE technique to measure myocardial SWV can be applied to assess the stiffness differences between normal myocardium and HCM myocardium. Additionally, SWV is correlated with left ventricular diastolic function indices and can effectively evaluate the diastolic dysfunction of the left ventricle caused by HCM.

Abstract 4142798: Differences in Clinical presentation in Spontaneous Coronary Artery Dissection vs. Type 1 Myocardial Infarction

Background: Spontaneous coronary artery dissection (SCAD) refers to the nontraumatic, non-iatrogenic, and nonatherosclerotic separation of the coronary artery wall leading to acute coronary syndrome. This condition predominantly affects women with minimal or no traditional cardiac risk factors. We aimed to determine the differences in clinical presentation between SCAD and Type 1 myocardial infarction (MI) in the Aurora Health Care community. Methods: A retrospective, matched cohort, multicenter community study was carried out on adult patients aged &gt;18 years admitted to all Aurora Hospitals from January 2012 to December 2022. A total of 57 patients were diagnosed with SCAD during that period. SCAD group and Type 1 MI group were matched by age and gender at a 1:5 ratio using a propensity score-based matching. Outcomes between the SCAD and the Type 1 MI groups were compared using chi-squared tests or Fisher’s exact tests, and t-tests or nonparametric equivalents (Wilcoxon). Results: A higher percentage of Type 1 MI patients presented as NSTEMI compared to SCAD patients (70% vs. 59.6%, p=0.028). Although not statistically significant, SCAD patients had a higher occurrence of STEMI than Type 1 MI patients (42.1% vs. 32.6%, p=0.169). On admission, SCAD patients had a higher maximum troponin (12,000 vs. 3,550, p=0.012). Type 1 MI patients had higher HgbA1C (6 vs. 5.4, p=0.0008). Both patients had similar LDL levels, but Type 1 MI had lower HDL levels (44 vs. 48, p=0.024). ESR, CRP, and D-dimer levels showed no significant difference. LV ejection fraction was 53% in both groups, and the LV global longitudinal strain was similar. The Type 1 MI group exhibited higher grades of diastolic dysfunction (Grade 2 and Grade 3) and mitral valve disease. E/e was higher in Type 1 MI compared to SCAD (11.5 vs 8.8, p &lt;0.0001). Type 2 SCAD was most prevalent at presentation, with the most frequently affected artery being LAD (47.4%) and the most frequently affected branch vessel being obtuse marginal (36.4%). The most common location was distal (59.6%), followed by mid (22.8%), with the diameter of the vessel involved mostly between 2-3.5 mm. Conclusion: This study observed that although more SCAD patients presented as STEMI with higher troponins, Type 1 MI patients were sicker overall. These differences in clinical findings can aid in diagnosis as the management of these two populations differ.

Computational simulation model of transcatheter edge-to-edge mitral valve repair: a proof-of-concept study.

As transcatheter mitral valve (MV) interventions are expanding and more device types and sizes become available, a tool supporting operators in pre-procedural planning and the clinical decision-making process is highly desirable. We sought to develop a finite element computational simulation model to predict the results of transcatheter edge-to-edge repair (TEER) interventions. We prospectively enrolled patients with secondary mitral regurgitation (MR) referred for a clinically indicated TEER. The 3D trans-oesophageal echocardiograms performed at the beginning of the procedure were used to perform the simulation. On the 3D dynamic model of the MV that was first obtained, we simulated the clip implantation using the same clip type, size, number, and implantation location that was used during the intervention. The 3D model of the MV obtained after the simulation of the clip implantation was compared with the clinical results obtained at the end of the intervention. We analysed the degree and location of residual MR and the shape and area of the diastolic MV area. We performed computational simulation on five patients. Overall, the simulated models predicted well the degree and location of the residual regurgitant orifice(s) but tended to underestimate the diastolic mitral orifice area. In this proof-of-concept study, we present preliminary results on our algorithm simulating clip implantation in five patients with functional MR. We show promising results regarding the feasibility and accuracy in terms of predicting residual MR and the need to improve the estimation of the diastolic MV area.

Mitral Annulus Calcium Score in Patients With Calcific Mitral Stenosis Undergoing Invasive Hemodynamic Assessment.

Aortic valve calcium score is associated with hemodynamic severity of aortic stenosis. Whether this association is present in calcific mitral stenosis remains unknown. This study was a retrospective analysis of consecutive patients with mitral stenosis secondary to mitral annular calcification (MAC) undergoing transseptal catheterization. All patients underwent invasive mitral valve assessment via direct left atrial and left ventricular pressure measurement. Computed tomography within 1 year of cardiac catheterization and with adequate visualization of the mitral annulus was included. MAC calcium score quantification by Agatston method was obtained offline using dedicated software (Aquarius, TeraRecon, V.4). Median patient age was 66.9±11.2 years, 47% of patients were women, 50% had coronary artery disease, 40% had atrial fibrillation, 47% had prior cardiac surgery, and 33% had prior chest radiation. Median diastolic mitral valve gradient was 9.4±3.4 mm Hg on echocardiography and 8.5±4 mm Hg invasively. Invasive median mitral valve area using the Gorlin formula was 1.87±0.9 cm2. Median MAC calcium score for the cohort was 7280±7937 Hounsfield units. MAC calcium score correlated with the presence of atrial fibrillation (P=0.02) but was not associated with other comorbidities. There was no correlation between MAC calcium score and mitral valve area (r=0.07; P=0.6) or mitral valve gradient (r=-0.03; P=0.8). MAC calcium score did not correlate with invasively measured mitral valve gradient and mitral valve area in patients with MAC-related mitral stenosis, suggesting that calcium score should not be used as a surrogate for invasive hemodynamic parameters.

Noninvasive Assessment of Cardiopulmonary Hemodynamics Using Cardiovascular Magnetic Resonance Pulmonary Transit Time.

Introduction: Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction (DD) and mitral valve regurgitation (MVR). Methods: We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant DD and MVR were defined as exceeding Grade I (impaired relaxation and mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula. Results: Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for the prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61-0.85; p = 0.001) for PTT and 0.81 (CI 0.71-0.89; p < 0.001) for nPTT. For MVR, the diagnostic performance amounted to an AUC of 0.80 (CI 0.68-0.92; p < 0.001) for PTT and 0.78 (CI 0.65-0.90; p < 0.001) for nPTT. PTT values < 8 s rule out the presence of DD and MVR with a probability of 70% (negative predictive value 78%). Conclusion: CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR-as assessed by echocardiography-unlikely.

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.

Auricle Myxoma, Evidence from the Clinic to Cardiovascular Emergency Surgery, Triad: Cardiac, Systemic, Embolic

Cardiac tumors are infrequent, primary tumors, such as atrial myxoma, are estimated at 000017 to 0.13% of all cardiac neoplasms, postmortem records, n relation to its frequency, it is more than the other primary ones, in 67% the left atrial myxoma, 23% in the right atrium and less frequent the biaurals left. age group from 30 to 60 years, more in the female sex, in the childhood is more related to alterations in skin lentiginosis, nevi as Carney.autosomica dominant síndrome. In genetic studies, alterations in the PRKAR1A gene on chromosome 17 are found. We present the case of a patient with a request for pre-surgical evaluation, urological prolapse of the bladder, with systemic manifestations, weight loss, chronic anemic syndrome treated with vitamins and trace elements, by a private physician, without remission. It is worth mentioning that the physical and cardiovascular examination revealed semiotic onygomatic seizures of Duroziez in the mitral area, with auscultatory changes in the left lateral decubitus position, for which reason I propose the diagnosis of mitral valvular heart disease vs atrial myxoma, with 2 elements of clinical judgment of the classic triad of myxoma, in the performance of the transcutaneous echocardiogram, a cardiac mass was observed, at the level of the left atrium, spherical, of 5.5 cmt diameter, hyperechogenic. Great mobility in cycles cardiac, prolapse of the mitral valve in diastole with stenosis, the emergency consultation was made to cardiovascular surgery in a hospital of greater complexity, a procedure with complete excision of the tumor of approx 12 cmt by 5.5 cmt diameter, with satisfactory evolution of the patient

Pathogenesis of pulmonary hypertension caused by left heart disease.

Pulmonary hypertension has high disability and mortality rates. Among them, pulmonary hypertension caused by left heart disease (PH-LHD) is the most common type. According to the 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension, PH-LHD is classified as group 2 pulmonary hypertension. PH-LHD belongs to postcapillary pulmonary hypertension, which is distinguished from other types of pulmonary hypertension because of its elevated pulmonary artery wedge pressure. PH-LHD includes PH due to systolic or diastolic left ventricular dysfunction, mitral or aortic valve disease and congenital left heart disease. The primary strategy in managing PH-LHD is optimizing treatment of the underlying cardiac disease. Recent clinical studies have found that mechanical unloading of left ventricle by an implantable non-pulsatile left ventricular assist device with continuous flow properties can reverse pulmonary hypertension in patients with heart failure. However, the specific therapies for PH in LHD have not yet been identified. Treatments that specifically target PH in LHD could slow its progression and potentially improve disease severity, leading to far better clinical outcomes. Therefore, exploring the current research on the pathogenesis of PH-LHD is important. This paper summarizes and classifies the research articles on the pathogenesis of PH-LHD to provide references for the mechanism research and clinical treatment of PH-LHD, particularly molecular targeted therapy.

Left Ventricular Diastolic Response to Isometric Handgrip Exercise in Physically Active and Sedentary Individuals.

This study aims to investigate the diastolic left ventricular (LV) response to isometric handgrip exercise among healthy middle-aged men with high physical activity levels, versus matched sedentary individuals. Two groups of 10 men aged 41-51 years were studied. Men in the first group had high weekly self-reported physical activity levels (&gt;3000 METs × min/week). In comparison, men in the second group reported low physical activity levels (&lt;300 METs × min/week). An isometric handgrip exercise (IHE) stress echocardiography test was performed in all of them. Both groups showed a similar and statistically significant increase in heart rate, systolic, diastolic, and mean arterial pressure following IHE. The group of active men under study did not show a statistically significant change in the ratio of early diastolic mitral valve inflow velocity to early diastolic lateral wall tissue velocity (E/e' ratio) in response to IHE. Conversely, the inactive participants' E/e' ratio was higher at peak activity in the isometric handgrip exercise. Apparently, healthy middle-aged men with high levels of physical activity seem to have an improved lusitropic cardiac function compared to men with low levels of physical activity, as observed by the different diastolic LV responses induced by isometric handgrip exercise.

Transcatheter aortic valve implantation (TAVI) with zero contrast in patients with impairment of renal function. A single centre experience

Abstract Transcatheter aortic valve implantation (TAVI) represents nowaday a safe and effective alternative to traditional surgery for patients with high and intermediate surgical risk. However, the risk of contrast induced nephropathy still remains a major concern and a real challenge in patients with baseline chronic kidney disease (CKD). Aim of our new approach, has been to find a solution capable to reduce or contain the incidence of acute renal damage after TAVI caused by the use of contrast dye in CKD patients. In the last twelve months, out of 85 patients admitted to our Center for severe symptomatic aortic stenosis, addressed to TAVI, 18 patients (mean age: 81.8 years, NYHA class III) presented CKD with mean creatinine value: 2.39 mg/dl; GFR: 24.46 ml/min/1.73 m2. Three patients had previously undergone surgical revascularization with coronary artery bypass graft and in 3 cases we performed a valve-in-valve procedure for degeneration of valvular bioprostheses.They were selected for our zero contrast protocol; all these patients underwent pre-procedural chest and abdomen CT scan without dye, together with a Lower Limb Eco-Color Doppler scan.Coronary angiography had been carried out in a previous hospitalization. The valve size choice was determined after measurements of the CT scan and echo images (both two- and three-dimensions) were compared. Data obtained (valve perimeter, area and the two main valve diameters) were strongly similar with the two techniques, without significant differences. The new valve deployment was monitored under constant fluoroscopy and transesophageal (TOE) visualization. A single pig tail catheter was placed in the non coronary sinus to facilitate valve annulus localization on fluoroscopy. The TOE selected view for TAVI deployment was the mid esophageal long axis. Proper prosthesis positioning was determined by measuring the protruding portion through the left ventricle outflow tract, and prevent possible impairment of diastolic mitral valve movement. In 17 cases a transfemoral percutaneous approach was used and only in one case surgical isolation of the right carotid artery was necessary due to the occlusion of every other peripheral access. Four patients needed a post implant dilatation for significant residual left ventricle/aortic gradient. All patients underwent the TAVI procedure successfully. In the post-TAVI phase, two patients underwent definitive PM implantation for third degree atrioventricular block despite adequately high implantation of the valve.At discharge, mean creatinine value was 1.9 mg/dl and mean GFR was 32.2 ml/min/1.73 m2. All patients survived the procedure and were discharged alive, after a further mean Hospital stay of four days. In conclusion, TAVI zero contrast is a safe, feasible and winning procedure to consider in patients with severely impaired renal function. Funding Acknowledgement Type of funding sources: None.

Left ventricular long-axis ultrasound strain (GLS) is an ideal indicator for patients with anti-hypertension treatment

ABSTRACT Background Primary hypertension is one of the most well-known risk factors for cardiovascular disease. Currently, there is still no ideal indicator for left ventricular end-diastolic pressure. Methods 73 hypertension patients and 37 healthy people were enrolled in this study. Each member was examined with conventional echocardiography including multiple indicators such as Peak mitral valve flow velocity (E, A), E/A, left atrial volume index (LAVl), tissue Doppler (PW-TDI) peak velocities during early and late diastolic mitral valve flow (e ‘), E/e ‘, and GLS. We have collected clinical data from all enrolled members. The above cardiac ultrasound indicators were obtained before the antihypertensive treatment, one month and three months after treatment. Results Left ventricular end-diastolic pressure (LVEDP) was positively correlated and negatively correlated with GLS (r = 0.638, P < .01) and E/e’ (r = −0.578, P < .05), respectively. The hypertensives had lower e’ value and higher values of GLS, E/e’, and LAVI than the control group (P < .05). GLS and E/e’ were significantly lower in hypertension group than those in the Control group after one month and three months of treatment (P < .05). The improvement rate of GLS was significantly higher than those in the improvement rate of e’, E/e’, LAVI after treatment (p < .05). Conclusion The GLS improvement rate was significantly higher than those of e’, E/e’ after one and three-month treatment. Therefore, GLS might be a potential ideal index for patients with anti-hypertension treatment. The results obtained in this study provide useful information for further study.

Hypertrophic cardiomyopathies requiring more monitoring for less atrial fibrillation-related complications: a clustering analysis based on the French registry on hypertrophic cardiomyopathy (REMY).

Defining the risk of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients is an important clinical and prognostic challenge. The aim of this study is to determine HCM phenogroups with different risk of AF occurrence at 5years. We applied retrospectively the Bayesian method, which can analyze a large number of variables, to differentiate phenogroups of patients with different risks of AF and prognoses across a French prospective on-going hospital-based registry of adult HCM patients (REMY). Clinical and imaging data were prospectively recorded, and patients were followed for 5years. A total of 1431 HCM patients were recruited, including 1275 analyzed in the present study after exclusion criteria. The population included 412 women, 369 patients with obstructive HCM, and 252 implanted with an ICD. AF occurred in 167 (11.6%) patients during the 5year follow-up. Three phenogroups were defined according to their common clinical and echocardiographic characteristics. Patients at the highest risk were oldest, more often female, with more frequent comorbidities, anteroposterior diameter of the left atrium was significantly greater, with diastolic dysfunction, outflow-tract obstruction, and mitral valve abnormality, and presented higher pulmonary artery pressure and/or right-ventricular dysfunction. These also had a higher risk of all-cause hospitalizations and death. Based on a clustering analysis, three phenogroups of HCM according to the risk of AF occurrence can be identified. It can indicate which patients should be more monitored and/or treated, particular to prevent the risk of stroke.

Risk of atrial fibrillation in hypertrophic cardiomyopathy: A clustering analysis based on the French registry on hypertrophic cardiomyopathy (REMY)

Paroxysmal or chronic atrial fibrillation (AF) is frequent in hypertrophic cardiomyopathy (HCM), occurring in more than 20%-25% of patients, and is often considered as an important turning point for the quality of life of these patients. Defining the risk of atrial fibrillation in hypertrophic cardiomyopathy patients is an important clinical and prognostic challenge. The aim of this study is to determine HCM-phenogroups with different risk of AF-occurrence at 5-year. We applied retrospectively the Bayesian method, which can analyze a large number of variables, to differentiate phenogroups of patients with different risks of AF and prognoses across a French prospective on-going hospital-based registry of adult HCM patients (REMY). Clinical and imaging data were prospectively recorded, and patients were followed for 5 years. A total of 1431 HCM patients were recruited, including 1275 analyzed in the present study after exclusion criteria. The population included 412 women, and 369 patients with obstructive HCM. AF-occurred in 167 (11.6 %) patients during the 5-year follow-up. Three phenogroups were defined according to their common clinical and echocardiographic-characteristics. Patients at the highest risk were oldest, more often female, with more frequent comorbidities, anteroposterior diameter of the left atrium was significantly greater, with diastolic dysfunction, outflow-tract obstruction and mitral valve abnormality, and presented higher pulmonary artery pressure and/or right ventricular dysfunction. These also had a higher risk of all-cause hospitalizations and death. Based on a clustering analysis, three phenogroups of HCM according to the risk of AF occurrence can be identified. It can indicate which patients should be more monitored and/or treated, particular to prevent the risk of stroke.

ВСЁ НОВОЕ – ЭТО ХОРОШО ЗАБЫТОЕ СТАРОЕ: АННУЛОПЛАСТИКА МИТРАЛЬНОГО КЛАПАНА АУТОПЕРИКАРДОМ ПРИ ДЕГЕНЕРАТИВНЫХ ПОРОКАХ

Objective: To present the first-hand results of a modified mitral annuloplasty (MA) with an autopericardial strip (APS) in degenerative mitral valve disease (DMVD). Methods: Fifty-three patients with DMVD (mean age, 54.9±9.5 years (36-78 years); n=32 men (60.4%) and n=21women (39.6%)) undergoing MA with an APS, between January 2017 and January 2020 were retrospectively studied. In the overwhelming majority of cases, triangular and quadrangular resections of the P2 segment were performed. In addition, in some cases, neochords were implanted to the A2 segment. Intraoperatively, the result of MA was considered satisfactory if, according to transoesophageal echocardiography, the degree of mitral regurgitation (MR) did not exceed grade 1. Results: No in-hospital mortality was observed. One female patient had an early relapse caused by the rupture of one of the neochords at the A2 segment. However, the MR did not exceed grade 2, and the patient was actively followed up. Conclusion: Individual APS length selection avoids overcorrecting and achieves adequate systolic and diastolic mitral valve performance. Keywords: Annuloplasty, mitral regurgitation, autopericardium, mitral regurgitation.

Motion-Mode Echocardiographic Measurement of Cardiac Dimensions in Goats and Sheep

Echocardiographic measurement of cardiac dimensions is a prerequisite for research and clinical studies of cardiac diseases. These echocardiographic values are not available in Black Bengal goats and Muzaffarnagari sheep. Therefore, the present study was undertaken to determine the reference motion (M)-mode echocardiographic values and investigate the species-specific differences between them. M-mode echocardiographic examination was performed in clinically healthy adult non-pregnant female Black Bengal goats (n = 20) and Muzaffarnagari sheep (n = 20). Mitral valve (MV), left ventricular (LV), left atrial and aortic dimensions were measured, and parameters for systolic function were calculated. Among MV measurements, significantly (p < 0.01) higher mean velocity of early diastolic opening and mitral valve excursion amplitude was seen in Muzaffarnagari sheep as compared to Black Bengal goats. Among LV dimensions, significantly (p < 0.001) higher interventricular septal thickness at peak systole, LV internal diameter at end diastole, LV posterior wall thickness at peak systole, LV internal volume at end diastole, relative wall thickness at peak systole, mean wall thickness at end diastole, mean wall thickness at peak systole and LV mass were seen in Muzaffarnagari sheep as compared to Black Bengal goats. Established echocardiographic values in these species may be used as a reference for physiological and cardiovascular studies in future.

Mitraclip for high risk patients with barlow mitral valve disease

Abstract Background No data have been published to now about the outcomes of MitraClip in inoperable patients with Barlow's Mitral Valve Disease. Despite the technical advantages of the new generation of MitraClips, the length and the thickness of the mitral leaflets and presence of flails with complete eversion and pseudo-cleft are challenging MitraClip procedure. Purpose To analyse the results of MitraClip in inoperable patients with Barlow's disease of Mitral valve. Methods We retrospectively collected the cases of MR in Barlow's disease treated with MitraClip in our institution from 2012 to 2018. The case were included in the analysis in presence of the following characteristics: bileaflet billowing or prolapse [or both], excessive leaflet tissue, and annular dilatation with or without calcification. Results We included in this analysis 59 patients (mean age 78±8 years, STS mortality score 4±2.9%). Echo data at baseline showed normal left ventricle ejection fraction and diastolic volume and increased left atrial volume index. Half of the included patients had a chordal rupture (n=27, 47%) and in 14 patients (23%) calcification of annulus and/or leaflet was diagnosed. The mean procedural time was 92±41min with a technical success (M-VARC) of 100% and more than 80% of patients requiring more than 1 clip. At 30 days follow-up the device success and the procedural success were respectively 59% and 56%. The mean diastolic mitral valve gradient was 3.1±1.5mmHg. At 30 days follow-up, 91% of the patients were NYHA class II stable patients; no death and no hospitalization occurred. During a median follow-up time of 412 days (IQR: 209–992 days) death for any cause occurred in 23% of the patients (n=14) and 16% of the patients (n=10) died because of a cardiovascular cause; 10 patients were re-hospitalized for heart failure and 5% of the patients (n=3) underwent an open-heart surgery at follow-up time. At univariate cox regression analysis the 1-Y composite end-point (death for any cause, HF re-hospitalization, MV surgery) was predicted by LV dimensions and 30 days procedural success. Conclusions To our knowledge, this is the first analysis of outcomes of Barlow's disease treated with MitraClip. Despite a high incidence of MR recurrence, we observed a good clinical response in term of NYHA class and mortality rate. Left ventricle size and 30-day procedural success predict outcomes. Funding Acknowledgement Type of funding source: None

Automated mitral valve vortex ring extraction from 4D-flow MRI.

PurposeTo present and validate a method for automated extraction and analysis of the temporal evolution of the mitral valve (MV) vortex ring from MR 4D‐flow data.MethodsThe proposed algorithm uses the divergence‐free part of the velocity vector field for Q criterion‐based identification and tracking of MV vortex ring core and region within the left ventricle (LV). The 4D‐flow data of 20 subjects (10 healthy controls, 10 patients with ischemic heart disease) were used to validate the algorithm against visual analysis as well as to assess the method’s sensitivity to manual LV segmentation. Quantitative MV vortex ring parameters were analyzed with respect to both their differences between healthy subjects and patients and their correlation with transmitral peak velocities.ResultsThe algorithm successfully extracted MV vortex rings throughout the entire cardiac cycle, which agreed substantially with visual analysis (Cohen’s kappa = 0.77). Furthermore, vortex cores and regions were robustly detected even if a static end‐diastolic LV segmentation mask was applied to all frames (Dice coefficients 0.82 ± 0.08 and 0.94 ± 0.02 for core and region, respectively). Early diastolic MV vortex ring vorticity, kinetic energy and circularity index differed significantly between healthy controls and patients. In contrast to vortex shape parameters, vorticity and kinetic energy correlated strongly with transmitral peak velocities.ConclusionAn automated method for temporal MV vortex ring extraction demonstrating robustness with respect to LV segmentation strategies is introduced. Quantitative vortex parameter analysis indicates importance of the MV vortex ring for LV diastolic (dys)function.

P1085EFFECT OF INTRAVASCULAR FLUID REMOVAL ON THE RATE OF CHANGE OF THE INFERIOR VENA CAVA DIAMETER, EARLY DIASTOLIC MITRAL VALUE INFLOW AND NUMBER OF LUNG ECHO B-LINES IN HEMODIALYSIS PATIENTS

Abstract Background and Aims In hemodialysis therapy, intravascular fluid is removed first. As intravascular water is removed, the circulating serum protein concentrations increase, resulting in a marked increase in the driving force which pulls water from the extravascular space into the blood vessels, by a process called plasma refilling. We examined the effect of total fluid removal and intravascular fluid removal as estimated by the change of the hematocrit value during dialysis on the rate of change of the inferior vena cava (IVC) diameter, early diastolic mitral valve inflow (E wave), and lung echo B-lines. Method We enrolled 59 patients under maintenance hemodialysis for this study. Lung ultrasound was performed at the first session of the week. Bilateral scanning of the anterior and lateral chest walls was performed with the patient in a supine position. The chest wall was divided into 8 areas (2 anterior and 2 lateral areas per side), and 1 scan was obtained for each area. The total number of B-lines was estimated. Echocardiographic measurements were obtained at the same time and the IVC dimensions and E wave were estimated. We performed each ultrasound examinations at two time-points (just after the start and just before the end of the hemodialysis therapy). We then investigated the rate of change ((post-pre)/post) of the IVC diameter, E wave, and number of B-lines. A peripheral blood sample was obtained before and after the hemodialysis session and the hematocrit was measured. We estimated the intravascular fluid volume as pre body weight /13, and estimated intravascular fluid removal as (post hematocrit – pre hematocrit)/post hematocrit x estimated intravascular fluid. We also defined estimated extravascular fluid removal as total fluid removal – estimated intravascular fluid removal. We investigated the relationship between the total, intravascular and extravascular fluid removals and the rate of change of the IVC diameter, E wave, and number of B-lines. Results The rate of change of the IVC diameter was negatively related to the estimated intravascular fluid volume (r=-0.285, P=0.033), but not to the estimated extravascular fluid or total fluid removal. The rate of change of the E wave was negatively related to the estimated intravascular fluid volume (r=-0.422, P=0.001), and the estimated extravascular fluid (r=-0.369, P=0.006) and total fluid removal (r=-0.419, P=0.002). Among these, the rate of change of the E wave was most closely related to the estimated intravascular fluid volume. The rate of change of the number of B-lines was not associated with the estimated intravascular fluid volume, but was negatively correlated with the estimated extravascular fluid (r=-0.368, P=0.005) and total fluid removal (r=-0.353, P=0.008). The estimated extravascular fluid removal was the most closely related to the rate of change of the number of B-lines. Conclusion The rates of changes of the IVC diameter and E wave were strongly associated with the estimated intravascular fluid removal, whereas the rate of change of the number of B-lines was correlated with estimated extravascular fluid removal. The E wave represents the flow to the left ventricle, which occurs after left ventricular diastole, reflecting the preload status. The IVC dimensions are strongly associated with the right atrial pressure and blood volume and therefore reflect the intravascular volume. Therefore, both the E wave and the IVC diameter may represent the intravascular fluid volume. On the other hand, the number of B-lines has been reported to be correlated with the amount of extravascular lung water. Our results were consistent with these reports.

Mechanisms and predictors of ischemic mitral regurgitation at rest and on exertion in patients at early stage of myocardial infarction

Aim. Determination of the mechanisms and predictors of ischemic mitral regurgitation (IMR) at rest and on exertion in patients at early stage of myocardial infarction (MI).Material and methods. Seventy-seven patients with inferoposterior MI and 79 patients with anteroseptal apical MI were examined on the 7th day at rest and after exertion. We determined the degree of IMR (according to the PISA method), posteromedial and anterolateral papillary muscle (PM) displacement, closure height of the mitral valve (MV), systolic and diastolic mitral valve orifice area, volume of the left ventricle (LV), LV contractility index, deformation of the infarction regions, general LV deformation, deformation and systolic dyssinchrony of the PM.Results. IMR was more common in inferior MI (42% vs 28%). LV volumes in cases with anteroseptal apical MI and IMR were greater and LV deformation was less than in patients without IMR. In inferoposterior MI and IMR, differences were observed in the index of local contractility and function of the posteromedial PM. The differences in MI of both localizations and IMR compared with MI without IMR were the areas of the mitral orifice and dyssinchrony of the PM. The degree of IMR after exertion did not depend on the degree of IMR at rest. Predictors of IMR at rest in MI of both localizations were the apical displacement of MV closure and the area of the mitral orifice. In inferoposterior, posteromedial PM displacement, deformation of the infarcted areas, PM dyssinchrony were also predictors. In anteroseptal apical MI, the area of the mitral orifice was the predictor of IMR. Predictors of anteroseptal apical MI after physical exertion after inferior MI were mitral orifice areas, contractility index, displacement and deformation of the posteromedial PM. In anteroseptal apical MI, the IMR predictors were MV closure height and systolic area of mitral orifice.Conclusion. The study confirms the significance of changing the spatial orientation of the MV structures in MI of both localizations, impaired regional contractility in inferoposterior MI and LV volume in anteroseptal apical MI at early stage of the disease.