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Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study

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Abstract

In a fraction of patients with mild mitral stenosis, left ventricular systolic function deteriorates despite the lack of hemodynamic load imposed by the dysfunctioning valve. Neither the predisposing factors nor the earlier changes in left ventricular contractility were understood adequately. In the present study we aimed to evaluate left ventricular mechanics using three-dimensional (3D) speckle tracking echocardiography. A total of 31 patients with mild rheumatic mitral stenosis and 27 healthy controls were enrolled to the study. All subjects included to the study underwent echocardiographic examination to collect data for two- and three-dimensional speckle-tracking based stain, twist angle and torsion measurements. Data was analyzed offline with a echocardiographic data analysis software. Patients with rheumatic mild MS had lower global longitudinal (p < 0.001) circumferential (p = 0.02) and radial (p < 0.01) strain compared to controls, despite ejection fraction was similar for both groups [(p = 0.45) for three dimensional and (p = 0.37) for two dimensional measurement]. While the twist angle was not significantly different between groups (p = 0.11), left ventricular torsion was significantly higher in mitral stenosis group (p = 0.03). All strain values had a weak but significant positive correlation with mitral valve area measured with planimetry. Subclinical left ventricular systolic dysfunction develops at an early stage in rheumatic mitral stenosis. Further work is needed to elucidate patients at risk for developing overt systolic dysfunction.

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References

  1. Feldman T (1996) Rheumatic heart disease. Curr Opin Cardiol 11:126–130

    Article  CAS  PubMed  Google Scholar 

  2. Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L (2011) The resurgence of rheumatic feverin a developed country area: the role of echocardiography. Rheumatology (Oxf) 50:396–400

    Article  Google Scholar 

  3. Chandrashekhar Y, Westaby S, Narula J (2009) Mitral stenosis. Lancet 374:1271–1283

    Article  CAS  PubMed  Google Scholar 

  4. Mohan JC, Khalilullah M, Arora R (1989) Left ventricular intrinsic contractility in pure rheumatic mitral stenosis. Am J Cardiol 64:240–242

    Article  CAS  PubMed  Google Scholar 

  5. Gash AK, Carabello BA, Cepin D, Spann JF (1983) Left ventricular ejection performance and systolic muscle function in patients with mitral stenosis. Circulation 67:148–154

    Article  CAS  PubMed  Google Scholar 

  6. Liu CP, Ting CT, Yang TM, Chen JW, Chang MS, Maughan WL et al (1992) Reduced left ventricular compliance in human mitral stenosis: role of reversible internal constraint. Circulation 85:1447–1456

    Article  CAS  PubMed  Google Scholar 

  7. Carabello BA (2005) Modern management of mitral stenosis. Circulation 112:432–437

    Article  PubMed  Google Scholar 

  8. Bilen E, Kurt M, Tanboga IH, Kaya A, Isık T, Ekinci M et al (2011) Severity of mitral stenosis and left ventricular mechanics: a speckle tracking echocardiography. Cardiology 119:108–115

    Article  PubMed  Google Scholar 

  9. Shantanu SP, Amaki M, Bansal M, Fulwani M, Washimkar S, Hofstra L et al (2014). Effects of percutaneous balloon mitral valvuloplasty on left ventricular deformation in patients with isolated severe mitral stenosis: a speckle tracking strain echocardiographic study. J Am Soc Echocardiogr 27:639–647

    Article  Google Scholar 

  10. Kirilmaz B, Asgun F, Saygı S, Ercan E (2015) Decreased left ventricular torsion in patients with isolated mitral stenosis. Herz 4(0):123–128

    Article  Google Scholar 

  11. Ozdemir AO, Kaya CT, Ozcan OU, Ozdol C, Candemir B, Turhan S et al (2010) Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis. Int J Cardiovas Imaging 26:397–404

    Article  Google Scholar 

  12. Sengupta PP, Mohan JC, Mehta V, Kaul UA, Trehan VK, Arora R et al (2004) Effect of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis:quantitative assessment by tissue velocity imaging. J Am Soc Echocardiogr 17:824–828

    Article  PubMed  Google Scholar 

  13. Omar AMS, Vallabhajosyula S, Sengupta PP (2015) Left ventricular twist and torsion research observations and clinical applications. Circ Cardiovasc Imaging 8:74–82

    Article  Google Scholar 

  14. Perez de Isla L, Vivas D, Zamorano J (2008) Three-dimensional speckle tracking. Curr Cardiovasc Imaging Rep 1:25–29

    Article  Google Scholar 

  15. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39.e14

    Article  PubMed  Google Scholar 

  16. Quinnones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature ans Standards Commitee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184

    Article  Google Scholar 

  17. Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618

    Article  CAS  PubMed  Google Scholar 

  18. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33:2451–2496

    Article  PubMed  Google Scholar 

  19. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA et al (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 63:2438–2488

    Article  PubMed  Google Scholar 

  20. Lee YS, Lee CP (1990) Ultrastructural pathological study of left ventricular myocardium in patients with isolated rheumatic mitral stenosis with normal or abnormal left ventricular function. Jpn Heart J 31:435–448

    Article  CAS  PubMed  Google Scholar 

  21. Holzer JA, Karliner JS, O’Rourke RA, Petersen KL (1973) Quantitative angiographic analysis of the left ventricle in patinets with isolated rheumatic mitral stenosis. Br Heart J 35:497–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ahmed SS, Regan TJ, Fiore JJ, Levinson GE (1977) The state of the left ventricular myocardium in mitral stenosis. Am Heart J 94:28–36

    Article  CAS  PubMed  Google Scholar 

  23. Gash AK, Carabello BA, Kent RL, Frazier JA, Spann JF (1984) Left ventricular performance in patients with coexistent mitral stenosis and aortic insufficiency. J Am Coll Cardiol 3:703–711

    Article  CAS  PubMed  Google Scholar 

  24. Kaku K, Hirota Y, Shimizu G, Kita Y, Saito T, Kawamura K (1998) Depressed myocardial contractility in mitral stenosis: an analysis by force-length and stress-shortening relationships. Jpn Circ J 52:35–43

    Article  Google Scholar 

  25. Heller JA, Carleton RA (1970) Abnormal left ventricular contraction in patinets with mitral stenosis. Circulation 42:1099–1110

    Article  CAS  PubMed  Google Scholar 

  26. Grant RP (1953) Architectonics of the heart. Am Heart J 46:405–431

    Article  CAS  PubMed  Google Scholar 

  27. Hernandez-Lattuf PR, Quinones MA, Gaasch WH (1974) Usefulness and limitations of circumferential fibre shortening velocity in evaluating segmental disorders of left ventricular contraction. Br Heart J 36:1167–1174

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ozdemir K, Altunkeser BB, Gok H et al (2004) Analysis of the myocardial velocities in patients with rheumatic mitral stenosis. Echocardiography 21:107–112

    Article  Google Scholar 

  29. Simsek Z, Karakelleoğlu S, Gundoğdu F et al (2010) Evaluation of left ventricular function with strain/strain rate imaging in patients with rheumatic mitral stenosis. Anadolu Kardiyol Derg 10:328–333

    Article  PubMed  Google Scholar 

  30. Doğan S, Aydın M, Gursurer M et al (2006) Prediction of subclinical left ventricular dysfunction with subclinical left ventricular dysfunction with strain rate imaging in patinets with mild to moderate rheumatic mitral stenosis. J Am Soc Echocardiogr 19:243–248

    Article  PubMed  Google Scholar 

  31. Sengupta SP, Amaki M, Bansal M, Fulwani M, Washimkar S, Hofstra L et al (2014) Effects of percutaneous balloon mitral valvuloplasty on left ventricular deformation in patients with isolated severe mitral stenosis: a speckle-tracking strain echocardiographic study. J Am Soc Echocardiogr 27:639–647

    Article  PubMed  Google Scholar 

  32. Yıldırımtürk O, Helvacıoğlu FF, Tayyareci Y, Yurdakul S, Aytekin S (2013) Subclinical left ventricular systolic dysfunction in patinets with mild-moderate rheumatic mitral stenosis and normal left ventricular ejection fraction: an observational study. Anadolu Kardiyol Derg 13:328–336

    PubMed  Google Scholar 

  33. Weiner RB, Weyman AE, Khan AM, Reingold JS, Chen-Tournoux AA, Scherrer-Crosbie M, Picard MH, Wang TJ, Baggish AL (2010) Preload dependency of left ventricular torsion:the impact of normal saline infusion. Circ Cardiovascular Imaging 3:672–678

    Article  PubMed  Google Scholar 

  34. Papadopoulou E, Kaladaridou A, Agrios J, Matthaiou J, Pamboukas C, Toumanidis S (2014) Factors influencing the twisting and untwisting properties of the left ventricle during normal pregnancy. Echocardiography 31:155–163

    Article  PubMed  Google Scholar 

  35. Weiner RB, Weyman AE, Kim JH, Wang TJ, Picard MH, Baggish AL (2012) The impact of isometric handgrip testing on left ventricular twist mechanichs. J Physiol 590:5141–5150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Park SJ, Nishimura RA, Borlaug BA, Soraja P, Oh JK (2010) The effect of loading alterations on left ventricular torsion:a simultaneous catheterizatiion and two-dimensional speckle tracking echocardiographic study. Eur J Echocardiogr 11:770–777

    Article  PubMed  Google Scholar 

  37. Kanzaki H, Nakatani S, Yamada N, Urayama S, Miyatake K, Kitakaze M (2006) Impaired systolic torsion in dilated cardiomyopathy: reversal of apical rotation at mid-systole characterized with magnetic resonance tagging method. Basic Res Cardiol 101:465–470

    Article  PubMed  Google Scholar 

  38. Gibbons Kroeker CA, Tyberg JV, Beyar R (1995) Effects of load maniplations, heart rate and contractility on left ventricular apical rotation. An experimental study in anesthetized dogs. Circulation 92:130–141

    Article  CAS  PubMed  Google Scholar 

  39. Van Dalen BM, Tzikas A, Soliman OI, Kauker F, Heuvelman HJ, Vletter WB et al (2011) Left ventricular twist and untwist in aortic stenosis. Int J Cardiol 148:319–324

    Article  PubMed  Google Scholar 

  40. Zito C, Carerj S, Todaro MC, Cusmá-Piccione M, Caprino A, Di Bella G et al (2013) Myocardial deformation and rotational profiles in mitral valve prolapse. Am J Cardiol 112:900–984

    Article  Google Scholar 

  41. Caso P, Ancona R, Di Salvo G, Comenale Pinto S, Macrino M, Di Palma V et al (2009) Atrial reservoir function by strain rate imaging in asymptomatic mitral stenosis: prognostic value at 3 year follow-up. Eur J Echocardiogr 10:753–759

    Article  CAS  PubMed  Google Scholar 

  42. Shin MS, Kim BR, Oh KJ, Bong JM, Chung WJ, Kang WC et al (2009) Echocardiographic assessments of left atrial strain and volume in healthy patients and patients with mitral valvular heart disease by tissue Doppler imaging and 3-dimensional echocardiography. Korean Circ J 39:280–287

    Article  PubMed  PubMed Central  Google Scholar 

  43. Tigen K, Pala S, Sadic BO, Karaahmet T, Dundar C, Bulut M, Izgi A et al (2014) Effect of increased severity of mitral regurgitation and preprocedural right ventricular systolic dysfunction on biventricular and left atrial mechanical functions following percutaneous mitral balloon valvuloplasty. Echocardiography 31(10):1213–1220. doi:10.1111/echo.12580

    Article  PubMed  Google Scholar 

  44. Barros-Gomes S, Eleid MF, Dahl JS, Pislaru C, Nishimura RA, Pellikka PA et al (2016) Predicting outcomes after percutaneous mitral balloon valvotomy: the impact of left ventricular strain imaging. Eur Heart J Cardiovasc Imaging. doi:10.1093/ehjci/jew160

    PubMed  Google Scholar 

  45. Ernande L, Bergerot C, Girerd N, Thibault H, Davidsen ES, Gautier Pignon-Blanc P et al (2014) Longitudinal myocardial strain alteration is associated with left ventricular remodeling in asymptomatic patients with type 2 diabetes mellitus. J Am Soc Echocardiogr 27:479–488

    Article  PubMed  Google Scholar 

  46. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J et al (2014) Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the EuropeanAssociationof Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 15:1063–1093

    Article  PubMed  PubMed Central  Google Scholar 

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The authors declare that no external sources of funding were used for the present study.

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Authors and Affiliations

  1. Department of Cardiology, Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Tıbbiye Street No:13, Kadıköy, Istanbul, Turkey

    Esra Poyraz, Tuğba Kemaloğlu Öz, Gönül Zeren, Tolga Sinan Güvenç, Cevdet Dönmez, Fatma Can, Rengin Çetin Güvenç & Şennur Ünal Dayı

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  1. Esra Poyraz
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  2. Tuğba Kemaloğlu Öz
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  3. Gönül Zeren
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  4. Tolga Sinan Güvenç
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  5. Cevdet Dönmez
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  6. Fatma Can
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  7. Rengin Çetin Güvenç
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Correspondence to Tolga Sinan Güvenç.

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None of the authors have any conflict of interests that is relevant for the present study.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Poyraz, E., Öz, T.K., Zeren, G. et al. Left ventricular mechanics in isolated mild mitral stenosis: a three dimensional speckle tracking study. Int J Cardiovasc Imaging 33, 1323–1330 (2017). https://doi.org/10.1007/s10554-017-1109-z

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  • DOI: https://doi.org/10.1007/s10554-017-1109-z

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