M. De Bonis

Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation

Objective: To assess whether tissue Doppler myocardial imaging (TDI) indices can predict postoperative left ventricular function in patients with mitral regurgitation (MR) after surgical correction. Methods: 84 patients (mean (SD) age 54.3 (10.8) years) with asymptomatic severe MR, an end systolic diameter < 45 mm, and an ejection fraction (EF) > 60% were subdivided in two groups: 43 patients with a postoperative EF reduction < 10% (group 1) and 41 patients with a postoperative EF reduction ⩾ 10% (group 2).TDI systolic indices of the lateral annulus were analysed preoperatively to assess myocardial systolic wave (Sm) velocity, myocardial precontraction time (PCTm), myocardial contraction time (CTm), and the PCTm:CTm ratio. Results: Postoperative EF decreased significantly (from 67 (5)% to 60 (5.5)%, p  =  0.0001). Group 2 had a higher PCTm, CTm, and PCTm:CTm ratio and a lower Sm velocity than group 1 (PCTm 100.4 (19) ms v 82 (21.8) ms, p  =  0.004; CTm 222 (3.1) ms v 215 (2.3) ms, p  =  0.01; PCTm:CTm 0.45 (0.08) v 0.38 (0.09), p  =  0.001; Sm velocity 10.4 (1.1) cm/s v 13 (1.3) cm/s, p  =  0.0001). Multivariate regression analysis showed that the combination of PCTm:CTm ratio ⩾ 40 ms and Sm velocity ⩽ 10.5 cm/s was the main independent predictor of postoperative EF reduction ⩾ 10% (sensitivity 78%, specificity 95%). Conclusions: TDI systolic indices can predict postoperative left ventricular function in patients with asymptomatic MR undergoing surgical correction.

Determinants of the degree of functional aortic regurgitation in patients with anatomically normal aortic valve and ascending thoracic aorta aneurysm. Transoesophageal Doppler echocardiography study

Objectives: To identify functional aortic regurgitation (FAR) determinants in patients with ascending thoracic aortic aneurysm (ATAA) and surgically confirmed normal aortic valve anatomy. Design: Case–control study. Setting: Non-invasive Cardiology and Cardiac Surgery Department. Patients: Eighty-nine patients with ATAA and varying degrees of FAR undergoing surgery, 40 age-matched patients with ATAA without aortic regurgitation and 20 normal control subjects. Interventions: Doppler and two-dimensional transoesophageal echocardiography. Main outcome measures: Vena contracta (VC) of aortic regurgitant jet, diastolic tented area and coaptation height (CH) of aortic valve leaflets, aortic dimension indexes—Valsalva sinus, sinotubular junction (STJ), tubular tract, annulus (A), STJ/A ratio. Results: When VC was used, a wide range of FAR was seen (mean (SD) 5.59 (2.59) mm, ranging from 2 to 13 mm). Of the variables tested, the most strongly associated with FAR severity in multivariate analysis was diastolic leaflet tenting, measured as CH (R2 = 0.69) (sensitivity 98%, specificity 95% using a cut-off value of CH ⩾1.1 cm). In turn, the diastolic leaflet tenting was strongly identified by the STJ/A ratio (sensitivity 87%, specificity 71% using a cut-off value of STJ/A >1.66). Conclusion: The diastolic tenting of aortic leaflets is strongly related to FAR severity in patients with ATAA. The mismatch of STJ/A is significantly associated with diastolic leaflet tenting and its correlated valve regurgitation, independently of the actual ATAA dimension. These findings provide new insight into the mechanism of FAR arising from ATAA.