Systolic Aortic Regurgitation Research Articles

Correlation of left atrial reservoir function with diastolic filling and stroke volume of the left ventricle in patients with rheumatic mitral stenosis

Abstract Funding Acknowledgements Type of funding sources: None. Correlation of left atrial reservoir function with diastolic filling and stroke volume of the left ventricle in patients with rheumatic mitral stenosis Introduction It has been theoretically known that the left atrium (LA) plays a key role in compensating for the lack of diastolic left ventricular (LV) filling induced by mitral stenosis (MS). However, due to the lack of adequate tools to assess the LA function, proving this concept turned out to be difficult. With the recent introduction of two-dimensional (2D) Speckle Tracking Echocardiography (STE) for exploring LA mechanics, this concept can be demonstrated. Purpose To assess correlation between LA reservoir function determined by 2D STE derived global strain and LV filling and stroke volumes. Methods We prospectively performed comprehensive trans thoracic echocardiography (TTE) in patients with rheumatic MS. Basic echocardiographic parameters were recorded, including indexed LA volume, mitral valve area (MVA) using planimetry and pressure half time (PHT), trans mitral mean gradient, maximal trans tricuspid velocity (MTTV), mitral inflow using continuity equation and LV stroke volume. Studied parameters represent the mean of at least three consecutive cardiac cycles. LA global strain curve and peak reservoir strain data were obtained on a standard four-chamber view using STE technique. Results We enrolled a total of 186 patients with rheumatic MS between February 2018 and February 2021. The mean age of our cohort was 50.55 ± 12.07 yrs. A number of patients were thereafter excluded from the study due to impaired systolic LV function (n = 12), severe mitral or aortic regurgitation (n = 7, n = 1 respectively). A total of 69.4% of our cohort were female (n = 129), 56.2% (n = 104) had history of percutaneous transvenous mitral commissurotomy (PTMC), 59.9% had permanent atrial fibrillation (n = 109) and 15,2% had history of ischemic stroke (n = 28). The most prominent comorbidities were hypertension (16.3%, n = 30) and diabetes mellitus (15.8%, n= 29). The mean 2D MVA was 1.40 ± 0.47 cm², mean PHT derived MVA was 1.47 ± 0.52 cm², mean gradient was 10.72 ± 5.82 mmHg, mean indexed LA volume was 80.70 ± 45.34 ml/m² and mean MTTV was (3.09 ± 0.62m/s). The mean mitral inflow value was 85.80 ± 28.56 ml/beat and the mean stroke volume was 70.64 ± 25.51 ml/beat. First, we found a statistically significant correlation between LV stroke volume and 2D mitral valve area (r = 0.284, p < 0.001). Interestingly, LA peak reservoir phase correlated positively with mitral inflow (r = 0.377, p < 0.001) and LV stroke volume (r = 0.213, p = 0.008). It also correlated with MTTV (r= -0.234, p = 0.009). However, we did not find any correlation between indexed LA volume and mitral inflow (r=-0.068, p = 0.359) and a weaker correlation with LV stroke volume was demonstrated (r=-0.184, p = 0.014). Conclusion LA reservoir function assessed by 2D STE is well correlated with diastolic mitral inflow and LV stroke volume in patients with rheumatic MS.

Left ventricular myocardial deformation as measure of hemodynamic burden in congenital valvular aortic stenosis

BackgroundChanges in 2D echocardiography (2DE) speckle tracking imaging (STI) derived left ventricular (LV) strain (S) and strain rate (SR) precedes diminution of LV ejection fraction (LVEF) in adult valvular aortic stenosis (AS). We prospectively examined whether 2DE-STI derived multidirectional LV S and SR correlate with AS severity in children using LV mass index (MI) as the principal outcome variable. Methods52 children (10.4 ± 7.3 years) with isolated congenital AS were included; 13 mild (2.5 m/s < Vmax < 3.0 m/s), 25 moderate (3.0 m/s < Vmax < 4.0 m/s), and 14 severe (Vmax > 4.0 m/s). 2DE including Doppler and STI longitudinal strain (LS), strain rate (LSR), circumferential strain (CS), and strain rate (CSR) were measured. Univariate and multivariable linear regressions identified correlations between LVMI and strain indices. ResultsThree clinical and 2DE variables, and four strain indices were independently associated with LVMI. LVMI correlated positively with systolic blood pressure and aortic regurgitation, and negatively with LVEF. LVMI correlated positively with LSR (four-chamber) and CSR (basal), and negatively with segmental CS in the inferior (basal) and anteroseptal (distal) segments. LVMI showed significant inverse association with LS (P = .05), LSR (P < .001), CS (P < .005), and CSR (P < .0001), independent of AS severity. ConclusionsIndependent of clinical and 2DE findings including contemporaneous Doppler estimates of AS gradient, both longitudinal and circumferential strain indices correlate with LVMI as a measure of cumulative hemodynamic burden. This association implies subclinical LV dysfunction.

Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms.

Novel paediatric presentation of COVID-19 with ARDS and cytokine storm syndrome without respiratory symptoms.

Systolic aortic regurgitation predicts all-cause mortality and hospitalization in outpatients with heart failure and preserved ejection fraction.

OBJECTIVE:Systolic aortic regurgitation (SAR) is considered to be a specific sign of heart failure (HF). However, the prevalence and importance of SAR in patients with HF and preserved ejection fraction (HFpEF) are unknown. Therefore, we sought to examine the prevalence of SAR in HFpEF outpatients and its association with all-cause mortality and/or cardiovascular hospitalizations during a 1-year follow-up.METHODS:We enrolled 301 consecutive outpatients with HFpEF (mean age of 67.3±9.6 years, 53.5% women) and prospectively followed up for one year. Demographic, clinical, echocardiographic, and laboratory data were obtained at study entry. The composite endpoint of this study was all-cause mortality or HF-related hospitalizations in one year.RESULTS:SAR was noted in 30 (9.9%) of the patients, and 38 patients (12.6%) reached the primary endpoint. The primary composite endpoint in one year was higher for the patients with SAR (26.3%) compared to the patients without SAR (7.6%, p<0.001). After adjusting for important covariates, SAR remained independently associated with primary outcome (OR 2.315; 95% CI 1.188–5.477; p=0.008).CONCLUSION:To our knowledge, this is the first study to demonstrate that the presence of SAR is associated with adverse events in patients with HFpEF.

Acromegaly and ultrasound: how, when and why?

Acromegaly is a rare disease caused by an excess of growth hormone and insulin-like growth factor 1. It is usually diagnosed because of typical signs such as macroglossia, acral enlargement, jaw prognathism and malocclusion. Systemic complications are a major cause of morbidity and mortality in acromegaly, and many patients remain undiagnosed for several years. Increased ultrasound (US) application in the general population, and including among acromegaly patients, has revealed many suggestive features which, taken together with clinical suspicion, could induce suspicion of this disease. This review describes main US features in acromegaly. Echocardiography shows a typical cardiomyopathy, characterized by left ventricular hypertrophy, diastolic and systolic dysfunction, aortic and mitral regurgitation, and increased aortic root diameters. US preclinical markers of atherosclerosis, such as intima media thickness (IMT), seem also to be impaired. Visceromegaly and increased organ stiffness are other features of acromegaly, including enlarged prostate, kidneys, liver, and thyroid. In addition, other US findings are: renal cysts, micronephrolithiasis, impairment of renal haemodynamic parameters, gallstones and gallbladder polyps, hepatic steatosis, thyroid nodules, multinodular goiter, and polycystic ovaries. Musculoskeletal US findings are increased cartilage thickness, impaired density and elasticity of bones, nerve enlargement, carpal and cubital tunnel syndrome, and trigger finger. Acromegaly patients frequently present systemic complications and a diagnostic delay. US features of acromegaly are not specific, but could potentially have a key role in early detection of the disease in the presence of typical clinical features.

Systolic aortic regurgitation in rheumatic carditis: Mechanistic insight by Doppler echocardiography

BackgroundAortic regurgitation (AR) usually occurs in diastole in presence of an incompetent aortic valve. Systolic AR is a rare phenomenon occurring in patients with reduced left ventricular systolic pressure and atrial fibrillation or premature ventricular contractions. Its occurrence is a Doppler peculiarity and adds to the hemodynamic burden. AimRheumatic carditis is often characterised by acute or subacute severe mitral regurgitation (MR) due to flail anterior mitral leaflet and elongated chords. In patients with acute or subacute MR, developed left ventricular systolic pressure may fall in mid and late systole due to reduced afterload and end-systolic volume and may be lower than the aortic systolic pressure, causing flow reversal in aorta and systolic AR. Material and methods17 patients with acute rheumatic fever were studied in the echocardiography lab during the period 2005–2015. Five patients had severe MR of which two had no AR and hence were excluded from the study. Three young male patients (age 8–24 years) who met modified Jones’ criteria for rheumatic fever with mitral and aortic valve involvement were studied for the presence of systolic AR. ResultsIn presence of acute or subacute severe MR, flail anterior mitral valve and heart failure, all three showed both diastolic and late systolic AR by continuous-wave and color Doppler echocardiography. ConclusionSystolic AR is a unique hemodynamic phenomenon in patients with acute rheumatic carditis involving both mitral and aortic valves and occurs in presence of severe MR.

Diastolic mitral regurgitation following transcatheter aortic valve replacement: Incidence, predictors, and association with clinical outcomes

BackgroundDiastolic mitral regurgitation (DMR) results from atrioventricular conduction disturbances, acute aortic regurgitation, and/or marked elevation of left ventricular filling pressure. Generally benign, in some clinical circumstances DMR has presumed to result in hemodynamic decompensation. The aforementioned causes of DMR are frequently encountered in patients treated by transcatheter aortic valve replacement (TAVR) but its clinical significance in this setting has not been studied. We sought to investigate the incidence of DMR and its prognostic implications following TAVR. MethodsBaseline clinical and echocardiographic variables from a prospective TAVR registry were analyzed to determine the correlates of post-procedural DMR and its impact on late outcomes (all-cause mortality and the composite of mortality and readmission due to heart failure). ResultsOf 267 patients undergoing TAVR, post-procedural DMR was present in 25 (9.3%). Independent predictors of DMR included pacemaker implantation [OR=2.7 (95%CI 1.03–6.50)], post-procedural systolic MR and aortic regurgitation [OR=3.7 (1.20–10.80) and OR=4.1 (1.50–10.60), respectively], and use of self-expanding bioprostheses [OR=4.9 (1.60–21.0)]. The incidence of the combined endpoint of death and/or readmission for heart failure was higher in patients with versus those without DMR (25% vs. 41%, respectively, p=0.08), although this association did not attain statistical significance on multivariable analyses. Interaction term analysis indicated a trend toward a heightened risk for the composite endpoint among patients with post-procedural aortic regurgitation (≥moderate) in whom DMR occurred (χ2 2.94, p=0.09). ConclusionsAlthough DMR following TAVR is common (occurring in approximately 1 of 10 patients), it is not independently associated with an increased risk of death and/or readmission for heart failure. Therefore, DMR post TAVR is more likely a marker of cardiac dysfunction than a causative factor.

Accentuating systolic aortic regurgitation during premature ventricular systole.

Accentuating systolic aortic regurgitation during premature ventricular systole.

Accuracy of systolic aortic regurgitation in the diagnosis of heart failure: a predictive approach.

Systolic aortic regurgitation (SAR) is a curious phenomenon that has been found to be associated with heart failure (HF). We aimed to determine de diagnostic value of SAR as a black box predictive tool in patients with suspected HF admitted to hospital with dyspnea as leading symptom. Cross-sectional study including 269 consecutive patients admitted to hospital with dyspnea as leading symptom without definite clinical diagnosis. SAR was defined by echocardiography as the presence of blood flow from the aorta to the left ventricular outflow tract during a complete systole. The reference standard was the presence of HF diagnosis at discharge. SAR was present in 9 (3.3%) patients. Prevalence of HF was 40.3%. Specificity of SAR in the diagnosis of HF was high at 99.4% (95% CI 96.5-99.9%). Sensitivity was 7.5% (95% CI 3.9-14.2%). Positive predictive value (PPV) was 88.9% (95% CI 56.5-98.0%). Positive likelihood ratio was 11.85. Estimated PPV of SAR was significantly higher than 50% for any hypothetical prevalence of HF. In patients admitted to hospital with dyspnea, the finding of systolic aortic regurgitation in echocardiography has a high PPV for HF diagnosis at discharge.

SYSTOLIC AORTIC REGURGITATION: AN UNDERESTIMATED PHENOMENON RELATED TO HEART FAILURE PROGNOSIS?

Aortic regurgitation is largely a diastolic phenomenon, but systolic aortic regurgitation (Sys-AR) has been described in certain homodynamic situations. We evaluated the frequency of this mechanical incompetence phenomenon in relation to heart failure (HF) and the occurrence of major cardiovascular

Hemodynamic Impact and Outcome of Permanent Pacemaker Implantation Following Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) frequently requires postprocedural permanent pacemaker (PPM) implantation. We evaluated clinical and hemodynamic impact of PPM after TAVI. Clinical and echocardiographic data were retrospectively analyzed in 230 consecutive patients who underwent TAVI and echocardiography at baseline and after 6 months. Echocardiographic parameters included left ventricular ejection fraction (LVEF), left ventricular (LV) stroke volume, early mitral velocity/annulus velocity ratio (E/e'), right ventricular index of myocardial performance, systolic pulmonary artery pressure (SPAP), and aortic, mitral, and tricuspid regurgitation grades. Clinical outcomes included 2-year survival and cardiovascular and PPM-related event-free survival. The Medtronic CoreValve and Edwards Sapien prosthesis were used in 201 and 29 patients, respectively. PPM was required in 58 patients (25.4%). Two-year and event-free survival rates were similar between patients with and without PPM. At 6 months, patients with PPM demonstrated attenuated improvement in LVEF (-0.9 ± 8.7% vs 2.3 ± 10.8%, respectively, p = 0.03) and LV stroke volume (-2 ± 16 vs 4 ± 10 ml/m(2), respectively, p = 0.015), a trend toward smaller reduction in systolic pulmonary artery pressure (-1 ± 12 vs -6 ± 10 mm Hg, respectively, p = 0.09), and deterioration of right ventricular index of myocardial performance (-3 ± 17% vs 5 ± 26%, respectively, p = 0.05). The differences in post-TAVI aortic, mitral, and tricuspid regurgitation grades were insignificant. In conclusion, PPM implantation after TAVI is associated with reduced LVEF and impaired LV unloading. However, this unfavorable hemodynamic response does not affect the 2-year clinical outcome. The maintenance of clinical benefit appears to be driven by TAVI-related recovery of LV and right ventricular performance that mitigates unfavorable impact of PPM.

Left Ventricular Assist Device-Related Systolic Aortic Regurgitation

A 39-year-old woman underwent transesophageal echocardiography during heart transplantation after 2.5 years of support with a continuous-flow left ventricular assist device (cf-LVAD). The patient was admitted to the hospital when a donor heart became available, and did not present with any symptoms or signs of heart failure on cf-LVAD support. Color-flow imaging demonstrated pronounced systolic aortic regurgitation (AR) while the LVAD was providing full support. The development of this unusual LVAD-related systolic AR may involve dynamic changes in resistance to flow of the aortic valve of an unknown mechanism. In most cases involving a combination of cf-LVAD support and aortic valve incompetence, AR would manifest as a mild-to-moderate diastolic or continuous valve regurgitation.1 Surprisingly, the patient demonstrated pronounced systolic AR (Figure 1 and Movie in the online-only Data Supplement) on support with a …

Systolic aortic regurgitation: A not-so-rare phenomenon

In a normal cardiac cycle, aortic and pulmonary regurgitation are diastolic phenomena. Aortic regurgitation has been observed in ventricular systole in patients with arrhythmias, extracorporeal circulation and palliative surgical correction of complex congenital heart disease. Systolic aortic regurgitation is explained as the inability of the ventricular beat to overcome the aortic pressure in patients with valvular incompetence. Beyond its potential as an elegant quiz about heart physiology, clinical association of systolic aortic regurgitation with heart failure and syncope has been described. Illustrative examples of both aortic and pulmonary systolic regurgitation are presented, an image of "continuous" aortic regurgitation is displayed, and technical issues on its diagnosis are briefly commented.

Systolic aortic regurgitation: A rare phenomenon

We describe a case of an elderly man admitted to our hospital with syncope and a slow pulse rate. An echocardiogram showed both diastolic as well as systolic aortic regurgitation. Careful analysis of the clinical data, electrocardiogram and echocardiogram revealed that systolic aortic regurgitation was related to syncope in a very interesting fashion.

Treatment of Systolic Hypertension and Severe Asymptomatic Aortic Regurgitation

Treatment of Systolic Hypertension and Severe Asymptomatic Aortic Regurgitation

The Frequency of Systolic Aortic Regurgitation and Its Relationship to Heart Failure in a Consecutive Series of Patients

Although aortic regurgitation is a diastolic phenomenon, it has been observed during systole in a few cases. Our aims were to determine the incidence of systolic aortic regurgitation in routine clinical practice and to investigate the clinical profiles of patients with the condition. An exhaustive prospective study of all investigations performed by a hospital echocardiographic unit over one month was carried out. Systolic aortic regurgitation was detected in five out of a total of 216 investigations (2.3%). In all cases, the patient had some degree of heart failure. Overall, the condition was present in 5.9% of patients with heart failure. In one patient with atrial fibrillation, systolic aortic regurgitation disappeared and the patient's clinical status improved after atrioventricular node modulation using a cryoablation catheter. Systolic aortic regurgitation was not an exceptional occurrence in hospitalized patients. Moreover, it tended to be specifically associated with heart failure.

Systolic aortic regurgitation

Aortic regurgitation is normally a diastolic phenomenon. Echocardiographic images of systolic aortic regurgitation in a patient with atrial fibrillation and heart failure are presented, and haemodynamic interpretation is provided.

The association between isolated systolic hypertension and aortic regurgitation is not independent of age: the strong heart study

P-363 Key Words: Isolated Systolic Hypertension, Aortic Regurgitation, Left Ventricular Hypertrophy

Isolated systolic hypertension and aortic regurgitation

The aim of this study was to evaluate if the patients who suffer isolated systolic hypertension (ISH) show a significant association with aortic regurgitation (AR). The study was done with 89 patients (P), 35 men and 54 women, mean age, 66.2 ± 10.4 years, all suffer ISH and AR. For this purpose, we studied 2300 twenty four hour ambulatory blood pressure monitoring (ABPM) over a period of 4 year. We observed that 175 of them (8%) had ISH, defined like the average daytime levels of systolic blood pressure (SBP) ≥ 140 mm Hg and average daytime levels of diastolic blood pressure (DBP) ≤ 85. Of these 175 P, 89 of them underwent two-dimensional and Doppler echocardiographic (DEC) study. In the ABPM we evaluated the average daytime SBP and DBP, and in the DEC the presence or not of the AR, and we measured the aortic root size (ARS) and the maximum (MV) and medium (mV) aortic velocity. The patients were separated in 2 groups according on the presence of the AR. The results were analized using the X2, Students's t test, Anova and the Mann-Whitney test. A level of p < .05 were considered statistically significant. Without AR: 58 P (65,2%), 28 men and 30 women, mean age 63.3 ± 11 years, SBP: 149.4 ± 9.45, DBP: 77.4 ± 6.61, ARS: 32.1 ± 3.39, MV: 1.31 ± .26, mV: .89 ± .21. With AR: 31 P (34,8%), 7 men and 24 women (p < .033), mean age 69.1 ± 9.79 years (p < .015), SBP: 152.0 ± 10.5 (p = .232), DBP: 74.9 ± 7.56 (p = .099), ARS: 32.7 ± 3.82(p = .519), VM: 1.58 ± .79 (p = .216), mV: 1.14 ± .59 (p = .053). No significant differences were demonstrated among the values of the SBP and DBP in either hypertensive groups, nor in the relation to the severity of the AR, in the ARS, nor in the MV and mV. Only the older age (p < .015) and the female gender (p < .033) were related with the presence of AR and with the increased risk of suffer AR (Odds Ratio, LC 95%: 1.05 and 3 respectively). Isolated systolic hypertension does not seem to be associated in a significant way to the aortic regurgitation.

Systolic aortic regurgitation: A hemodynamic challenge for the clinician

Aortic regurgitation is considered a diastolic phenomenon. We describe a case in which premature beats resulted in a left ventricular systolic pressure that was lower than the aortic pressure, and thus aortic regurgitation continued throughout the systole of the premature beat. This sequence of events was clearly demonstrated by Doppler echocardiography.