Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction
- 308 Downloads
The indication for surgery in asymptomatic severe mitral regurgitation (SMR) with preserved left ventricular ejection fraction (LVEF) is controversial. We sought to study 3D myocardial mechanics in this population and test 3D-speckle tracking (3DST) parameters as possible predictors of events. 45 asymptomatic patients with SMR and LVEF >60 % and 20 control individuals without cardiac disease underwent 3DST echocardiography. MR group additionally underwent further clinical monitoring. Dyspnea, LVEF under 60 %, or admissions for heart failure were considered as events. When compared with control group, MR group showed lower percentage of global 3D strain, (35.4 ± 9.1 vs. 43.9 ± 10.6; p = 0.003), lower radial strain, lower area change rate and higher end-diastolic volume. In a follow-up time of 23.2 ± 14.5 months we found 15 events (33.3 %). When comparing the remaining patients with this new-onset HF group we found significant differences in longitudinal strain (−17.9 ± 3.3 vs. −15.8 ± 2.1; p = 0.036), area strain (AS) (−48.6 ± 4.6 vs. −43.7 ± 6.2; p = 0.006), circumferential strain (−35.8 ± 4.7 vs. −31.8 ± 6.1; p = 0.034), 3D LVEF (67.1 ± 4.6 vs. 63.0 ± 7.4; p = 0.034) and E/E′ index (13.5 ± 3.9 vs. 19.3 ± 9.5; p = 0.006). In multivariate Cox regression AS alone was the only independent predictor. A cutoff value of AS greater than −41.6 % reached a hazard ratio of 4.41 (p = 0.004) for prediction of events. In asymptomatic patients with SMR and preserved ejection fraction, 3DST derived AS is a promising tool for predicting the development of heart failure. This finding may be useful for guiding the selection of patients for early mitral valve repair/replacement surgery even if they are asymptomatic.
Keywords3D speckle-tracking Mitral regurgitation Area strain Cardiac mechanics Heart failure Echocardiography
All the authors declare that the paper is not under consideration elsewhere; none of the paper’s contents have been previously published; all authors have read and approved the manuscript.
There was no external funding.
Compliance with ethical standards
Conflict of interest
No conflicts of interest exist. No relationships with the industry are declared.
- 5.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP III, Guyton RA et al (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 129:2440–2492Google Scholar
- 6.Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H et al (2012) Joint Task Force on the Management of Valvular Heart Disease of the ESC, European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496CrossRefPubMedGoogle Scholar
- 9.Mor-Avi V, Lang RM, Badano LP, Belohlavek M, Cardim NM, Derumeaux G et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12(3):167–205CrossRefPubMedGoogle Scholar
- 10.Perez de Isla L, de Agustin A, Rodrigo JL, Almeria C, del Carmen Manzano M, Rodríguez E et al (2009) Chronic mitral regurgitation: a pilot study to assess preoperative left ventricular contractile function using speckle-tracking echocardiography. J Am Soc Echocardiogr 22(7):831–838CrossRefGoogle Scholar
- 11.De Agustín JA, Pérez de Isla L, Núñez-Gil IJ, Vivas D, Manzano Mdel C, Marcos-Alberca P et al (2010) Assessment of myocardial deformation: predicting medium-term left ventricular dysfunction after surgery in patients with chronic mitral regurgitation. Rev Esp Cardiol 63(5):544–553CrossRefPubMedGoogle Scholar
- 18.Badano LP, Cucchini U, Muraru D, Al Nono O, Sarais C, Iliceto S (2013) Use of three-dimensional speckle tracking to assess left ventricular myocardial mechanics: inter-vendor consistency and reproducibility of strain measurements. Eur Heart J Cardiovasc Imaging 14(3):285–293CrossRefPubMedGoogle Scholar
- 21.Florescu M, Benea DC, Rimbas RC, Cerin G, Diena M, Lanzzillo G et al (2012) Myocardial systolic velocities and deformation assessed by speckle tracking for early detection of left ventricular dysfunction in asymptomatic patients with severe primary mitral regurgitation. Echocardiography 29(3):326–333CrossRefPubMedGoogle Scholar
- 24.Saito K, Okura H, Watanab N, Hayashida A, Obase K, Imai K et al (2009) Comprehensive evaluation of left ventricular strain using speckle tracking echocardiography in normal adults: comparison of three-dimensional and two-dimensional approaches. J Am Soc Echocardiogr 22(9):1025–1030CrossRefPubMedGoogle Scholar