Sorina Mihaila

Normal Left Ventricular Mechanics by Two-dimensional Speckle-tracking Echocardiography. Reference Values in Healthy Adults

INTRODUCTION AND OBJECTIVES Two-dimensional speckle-tracking echocardiography is a novel tool to assess myocardial function. The purpose of this study was to evaluate left ventricular myocardial strain and rotation parameters by two-dimensional speckle-tracking echocardiography in a large group of healthy adults across a wide age range to establish their reference values and to assess the influence of age, sex, and hemodynamic factors. METHODS Transthoracic echocardiograms were acquired in 247 healthy volunteers (139 women, 44 years [standard deviation, 16 years old] (range, 18-80 years). We measured longitudinal, circumferential, and radial peak systolic strain values, and left ventricular rotation and twist. RESULTS Average values of global longitudinal, radial, and circumferential strain were -21.5% (standard deviation, 2.0%), 40.1% (standard deviation, 11.8%) and -22.2% (standard deviation, 3.4%), respectively. Longitudinal strain was significantly more negative in women, whereas radial and circumferential strain and rotational parameters were similar in both sexes. Accordingly, lower limits of normality for the strain components were -16.9% in men and -18.5% in women for longitudinal strain, and -15.4% for circumferential and 24.6% for radial strain, irrespective of sex. Longitudinal strain values were more negative at the base than at apical segments. Mean rotational values were -6.9° (standard deviation, 3.5°) for the base, 13.0° (standard deviation, 6.5°) for apical rotation, and 20.0° (standard deviation, 7.3°) for net twist. CONCLUSIONS We report the comprehensive assessment of normal myocardial deformation and rotational mechanics in a large cohort of healthy volunteers. We found that women have more negative longitudinal strain, accounting for their higher left ventricular ejection fraction. Availability of reference values for these parameters may foster their implementation in the clinical routine.

Growth Hormone Deficiency in Adults Impacts Left Ventricular Mechanics: A Two-Dimensional Speckle-Tracking Study

BACKGROUND Growth hormone deficiency (GHD) in adults is associated with increased cardiovascular events, but detailed assessment of cardiac and vascular function is lacking. Thus we assessed cardiac, arterial, and endothelial functions, using conventional and speckle-tracking echocardiography, in adults with GHD compared with controls with similar cardiovascular risk. METHODS Fifty-two patients with GHD (47 ± 16 years; 34 men) and no cardiovascular disease or diabetes were enrolled prospectively and compared with 50 age- and sex-matched controls. Comprehensive echocardiography was performed in all participants. Regional left ventricular (LV) function was assessed from global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS), whereas LV torsion (LVtor) was calculated from basal (RotB) and apical (RotA) rotations. Arterial function was assessed from intima-media thickening, local wave speed, and beta index of stiffness, whereas endothelial function was assessed from flow-mediated dilation. Levels of pro-brain natriuretic peptide (proBNP) were measured. RESULTS GLS and GCS were decreased more in patients with GHD than in controls (-17.2% ± 2.7% vs. -19.3% ± 3.3% and -15.9% ± 5.4% vs. -18.8% ± 3.5%; both P < 0.01), whereas GRS was similar. RotB and LVtor were also decreased in patients with GHD (-4.8° ± 2.6° vs. -6.2° ± 2.1°/cm and 1.8° ± 0.6° vs. 2.3° ± 1.1°/cm; both P < 0.05). ProBNP was increased in patients with GHD (61.0 ± 74 pg/dL vs. 24.7 ± 21 pg/dL; P = 0.002). Arterial and endothelial functions were similar between groups. CONCLUSIONS In conclusion, adults with GHD had LV longitudinal dysfunction and increased proBNP levels compared with controls, suggesting intrinsic myocardial disease. Further studies are needed to assess if this cardiac impairment in adults with GHD is reversible after GH replacement.

Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodelling in patients with primary mitral regurgitation

AIMS To explore the relationship between the mitral annular (MA) remodelling and dysfunction, mitral regurgitation (MR) severity, left ventricular (LV) and atrial (LA) size and function in patients with organic MR (OMR). METHODS AND RESULTS A total of 52 patients (57 ± 15 years, 31 men) with mild to severe OMR and 52 controls underwent 3D transthoracic echocardiography acquisitions of the mitral valve (MV), LA, and LV. MA geometry and dynamics, LV and LA volumes, LV ejection fraction (LVEF) and emptying fractions (LAEF) were assessed using dedicated software packages. LA and LV myocardial deformations were assessed using 2D speckle-tracking echocardiography. OMR patients presented larger and more spherical MA than controls during the entire systole (P < 0.001). Although the MA non-planarity at early-systole was similar between OMR and controls (157 ± 13° vs. 153 ± 12°, P = NS), the MA became flatter from mid- to end-systole (153 ± 12 vs. 146 ± 10° and 157 ± 12 vs. 147 ± 8°, P < 0.01) in OMR. MA area fractional change was lower in patients with OMR (22 ± 5% vs. 28 ± 5%, P < 0.001), and correlated with the MR orifice and volume (r = -0.52 and r = -0.55). MA fractional area change correlated with LA minimum and maximum volumes (r = 0.77 and r = 0.70), total and active LAEF (r = 0.72 and r = 0.76), and LA negative strain and strain rate (r = 0.52 and r = 0.57), but not with the LVEF or LV global longitudinal strain. In a multivariate regression model using LAEF and LVEF, solely active LAEF correlated with the MA fractional area change (β = 0.51, P = 0.005). CONCLUSION In patients with OMR, MA reduced function correlates with the MR severity and the LA size and function, but not with the LV function.

Isolated Anterior Mitral Valve Leaflet Cleft: 3D Transthoracic Echocardiography-Guided Surgical Strategy.

Isolated cleft of the anterior mitral leaflet (not associated with atrioventricular septal defect) is a rare cause of congenital mitral regurgitation. When feasible, mitral valve repair (direct suturing of the cleft with or without prosthetic annular ring insertion) is preferable to valve replacement. We report a clinical case in which we describe the usefulness of three-dimensional (3D) transthoracic echocardiography (TTE) for diagnosis and morphological assessment of the defect to assist in planning the surgical procedure.

GESTATIONAL HYPERTENSION AND PREECLAMPSIA ARE ASSOCIATED WITH SUBCLINICAL LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC DYSFUNCTION

Background: Gestational hypertension (GHT) and preeclampsia (PE) are associated with a significant and early cardiovascular risk, however effect of these conditions on cardiac function is insufficiently studied. Methods: We performed a very detailed echo study to evaluate subclinical changes of

Functional Classification of Secondary Mitral Valve Regurgitation

Secondary mitral regurgitation (SMR) is defined as an insufficiency of the mitral valve, due to an abnormal function of normal valve leaflets, related to impaired left ventricular (LV) function (Lancellotti et al., Eur J Echocardiogr 11(4):307–32, 2010). Some authors consider it to be a ventricular disease with a “valvular phenotype” (Komeda et al., Circ J 73(Suppl A):A23–8, 2009).

THE SEVERITY OF FUNCTIONAL MITRAL REGURGITATION ASSESSED BY THREE-DIMENSIONAL ECHOCARDIOGRAPHY: NEW CUT-OFFS ARE NEEDED

The assessment of functional mitral regurgitation severity (FMR) using two-dimensional echocardiography (2DE) PISA method is limited because of the dynamic changes in shape and size of both effective regurgitant orifice (EROA) and PISA during systole. The assessment of MR severity using three-

SUCCESSFUL THROMBOLISYS FOR MOBILE MASSIVE RIGHT HEART THROMBOSIS

Right heart thrombi, particularly when mobile, are associated with significantly high risk of early mortality in patients with acute pulmonary embolism, up to 80-100% when left untreated. Urgent therapy is mandatory. However, guidelines recommendations for the treatment of choice, thrombolysis or

QUANTITATIVE ANALYSIS OF THE MITRAL ANNULUS GEOMETRY AND FUNCTION IN HEALTHY VOLUNTEERS: A TRANSTHORACIC THREE-DIMENSIONAL ECHOCARDIOGRAPHY STUDY

Mitral valve (MV) quantitative analysis using 3D transthoracic echo (3DTTE) and dedicated software provides new insights into function of normal and pathological mitral annulus (MA). However, reference values for MA dimensions and dynamics in healthy subjects remain to be established. 224 healthy

Changes in mitral annulus and leaflets size are related to regurgitation severity in organic mitral regurgitation: a three-dimensional transthoracic study

Background: Until recently, quantitative analysis of mitral valve annulus (MVA) dimensions in different types of mitral regurgitation (MR) was feasible only by transesophageal 3D echocardiography (3DE); data about the relationship of these quantitative parameters to MR severity are scarce. Objectives: Our aim was to assess if the changes in mitral annulus and leaflets of patients with organic MR are related to MR severity. Methods: 30 pts with moderate-severe organic MR (OMR) due to MV prolapse (57±14 yrs, 21 men, 28 pts with posterior leaflet prolapse) underwent 3D full-volume acquisition of the MV (32±2 fps) using Vivid E9 (BT 12, GE Healthcare, Horten, N). MR severity was quantitatively assessed according to current guidelines: vena contracta (VC), PISA radius (PISArad), effective regurgitant orifice (ERO), and MR volume (MRvol). Left atrial biplane volume was also measured. Several MV geometry parameters were measured at mid-systole with prototype software for 3DTTE (TomTec MV assessment 2.0, Unterschleissheim, D): antero-posterior annulus diameter (A-P diameter), anterolateral-posteromedial annulus diameter (AL-PM diameter), commissural diameter, 3D annulus circumference and area, anterior and posterior leaflet areas (ALA, PLA). Results: 3D annulus area and circumference correlated to PISArad (r=0.455, p=0.027; r=0.477, p=0.027), and MRvol (r=0.610, p=0.009; r=0.584, p=0.014) (Figure). Due to dominance of posterior leaflet prolapse, PLA was also related to MRvol (r=0.526, p=0.003). Moreover, a positive relationship was found between biplane LA volume and MVA area (r=0.630, p=0.001). ![Figure][1] Correlation for MVA size and MR severity Conclusion: In organic MR, quantitative analysis of MVA geometry by 3D TTE revealed that increased dimensions of MV leaflets and annulus, in addition to MV morphology, contribute to MR severity and LA volume. [1]: pending:yes