Russian Heart Failure Journal 2012year Systolic and diastolic function of the left ventricle at mitral valve prolapse


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Systolic and diastolic function of the left ventricle at mitral valve prolapse

Malev E. G., Reeva S. V., Timofeev E. V.,Pshepiy A. R., Korshunova A. L., Pankova I. A., Zemtsovskiy E. V.

Keywords: myocardium deromations, mitral valve prolapse, left ventricular systolic dysfunction

DOI: 10.18087 / rhfj.2012.1.1562

Relevance. Several studies showed reduced LV systolic function with Marfan disease and missing aortic regurgitation, which allowed us to assume possible myocardium dysfunctions, and with other hereditary connective tissue disorders. Objective. Assessment of LV function in asymptomatic young patients with mitral valve prolapse (MVP), without significant mitral regurgitation (МР) by spackle-tracking method. Materials and methods. 78 patients with MVP (mean age 19.7±1.6 years; 72 % male) were enrolled to the study. 80 healthy volunteers of comparable age were included to the control group. Axial deformation and deformation rate (DR) of myocardium were evaluated in three apical sections by spackle tracking (Vivid 7 Dim, EchoPAC’06, GE), frame frequency 50–55 per sec. Results. Two clusters of patients with MVP were allocated. The 1st cluster (17 patients, 28 % of all MVP group) showed significant decrease of global and regional axial systolic deformation and diastolic DR in comparison with the control group and the 2nd cluster (61 patients, 72 %). Global strain in the 2nd cluster did not differ significantly from the control group, but there were significant differences of local axial systolic deformations and diastolic DR: decrease in the septum and increase in the lateral, posterior and inferior walls. Conclusion. Use of modern hi-tech study methods allowed us to reveal several features of myocardium deformation characteristic of young asymptomatic MVP patients, which can be the first signs cardiomyopathy in hereditary connective tissue disorders, noogenesis of which requires further studies with use of magnetic resonance imaging and assessment of fibrosis markers.
  1. Grau JB, Pirelli L, Yu PJ et al. The genetics of mitral valve prolapse. Clin Genet. 2007;72 (4):288–295.
  2. Наследственные нарушения соединительной ткани. Российские рекомендации. Всероссийское научное общество кардиологов – секция дисплазии соединительной ткани. Кардиоваскулярная терапия и профилактика. 2009;8 (6) Приложение 5:1–24.
  3. Freed LA, Levy D, Levine RA et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med. 1999;341 (1):1–7.
  4. Freed LA, Benjamin EJ, Levy D et al. Mitral valve prolapse in the gene­ral population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Coll Cardiol. 2002;40 (7):1298–1304.
  5. Малев Э. Г., Реева С. В., Тимофеев Е. В., Земцовский Э. В. Современные подходы к диагностике и оценке распространенности пролапса митрального клапана у лиц молодого возраста. Российский кардиологический журнал. 2010;1:35–41.
  6. ACC / AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons.. J Am Coll Cardiol. 2006;48 (3):e1–148.
  7. Chatrath R, Beauchesne LM, Connolly HM et al. Left ventricular function in the Marfan syndrome without significant valvular regurgitation. Am J Cardiol. 2003;91 (7):914–916.
  8. Alpendurada F, Wong J, Kiotsekoglou A et al. Evidence for Marfan cardiomyopathy. Eur J Heart Fail. 2010;12 (10):1085–1091.
  9. Pope AJ, Sands GB, Smaill BH, LeGrice IJ. Three-dimensional transmural organization of perimysial collagen in the heart. Am J Physiol Heart Circ Physiol. 2008;295 (3):H1243‑H1252.
  10. Delhomme C, Casset-Senon D, Babuty D et al. A study of 36 cases of mitral valve prolapse by isotopic ventricular tomography. Arch Mal Coeur Vaiss. 1996;89 (9):1127–1135.
  11. Lumia FJ, LaManna MM, Atfeh M, Maranhao V. Exercise first-pass radionuclide assessment of left and right ventricular function and valvular regurgitation in symptomatic mitral valve prolapse. Angiology. 1989;40 (5):443–449.
  12. Casset-Senon D, Babuty D, Philippe L et al. Fourier phase analysis of SPECT equilibrium radionuclide angiography in symptomatic patients with mitral valve prolapse without significant mitral regurgitation: assessment of biventricular functional abnormalities suggesting a cardiomyopathy. J Nucl Cardiol. 2000;7 (5):471–477.
  13. Marciniak A, Claus P, Sutherland GR et al. Changes in systolic left ventri­cular function in isolated mitral regurgitation. A strain rate imaging study. Eur Heart J. 2007;28 (21):2627–2636.
  14. Lancellotti P, Cosyns B, Zacharakis D et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr. 2008;21 (12):1331–1336.
  15. Leung DY, Ng AC. Emerging clinical role of strain imaging in echocardio­graphy. Heart Lung Circ. 2010;19 (3):161–174.
  16. Козлов П. С., Малев Э. Г., Прокудина М. Н. и др. Деформация и скорость деформации – новые возможности количественной оценки регионарной функции миокарда. Артериальная гипертензия. 2010;16 (2):215–217.
  17. Dalen H, Thorstensen A, Aase SA et al. Segmental and global longitudinal strain and strain rate based on echocardiography of 1266 healthy individuals: the HUNT study in Norway. Eur J Echocardiogr. 2010;11 (2):176–183.
  18. Mor-Avi V, Lang RM, Badano LP et al. 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. 2011;12 (3):167–205.
  19. Lancellotti P, Moura L, Pierard LA et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010;11 (4):307–332.
  20. Lang RM, Bierig M, Devereux RB et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18 (12):1440–1463.
  21. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol. 1986;57 (6):450–458.
  22. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009 Mar; 10 (2):165–193.
  23. Flack JM, Kvasnicka JH, Gardin JM et al. Anthropometric and physiologic correlates of mitral valve prolapse in a biethnic cohort of young adults: the CARDIA study. Am Heart J. 1999;138 (3 Pt 1):486–492.
  24. Dalen H, Thorstensen A, Ingul CB et al. Normal values for diastolic strain rate from combined speckle tracking and Doppler tissue imaging. Preliminary data from the HUNT3‑study. Eur Heart J. 2009;30:320.
  25. Wang J, Khoury DS, Thohan V et al. Global diastolic strain rate for the assessment of left ventricular relaxation and filling pressures. Circulation. 2007;115 (11):1376–1383.
  26. Kasner M, Gaub R, Sinning D et al. Global strain rate imaging for the estimation of diastolic function in HFNEF compared with pressure-volume loop analysis. Eur J Echocardiogr. 2010;11 (9):743–751.
  27. Malev EG, Zemtsovsky EV, Reeva SV, Timofeev EV. Radial and circumferential strain and strain rate in healthy young adults. Eur J Echocardiogr. 2010;11 (Suppl 2):ii33.
  28. Bijnens BH, Cikes M, Claus P, Sutherland GR. Velocity and deformation imaging for the assessment of myocardial dysfunction. Eur J Echocardiogr. 2009;10 (2):216–226.
  29. Vitarelli A, Capotosto L, Rosato E et al. Echocardiographic myocardial imaging reveals segmental cardiomyopathy in Churg-Strauss syndrome. Tex Heart Inst J. 2010;37 (5):594–597.
  30. Han Y, Peters DC, Salton CJ et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008;1 (3):294–303.
  31. Sanfilippo AJ, Harrigan P, Popovic AD et al. Papillary muscle traction in mitral valve prolapse: quantitation by two-dimensional echocardiography. J Am Coll Cardiol. 1992;19 (3):564–571.
  32. Han Y, Peters DC, Kissinger KV et al. Evaluation of papillary muscle function using cardiovascular magnetic resonance imaging in mitral valve prolapse. Am J Cardiol. 2010 Jul 15;106 (2):243–248.
  33. Maron BJ, Towbin JA, Thiene G et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113 (14):1807–1816.
  34. Richardson P, McKenna W, Bristow M et al. Report of the 1995 World Health Organization / International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996;93 (5):841–842.
  35. Elliott P, Andersson B, Arbustini E et al. Classification of the cardiomyopathies: a position statement from the European Society Of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008;29 (2):270–276.
  36. Matos-Souza JR, Fernandes-Santos ME, Hoehne EL, et al. Isolated mitral valve prolapse is an independent predictor of aortic root size in a general population. Eur J Echocardiogr. 2010;11 (3):302–305.
Malev E. G., Reeva S. V., Timofeev E. V. et al. Systolic and diastolic function of the left ventricle at mitral valve prolapse. Russian Heart Failure Journal. 2012;13(1):26-31

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