© 2014, Wiley Periodicals, Inc. DOI: 10.1111/echo.12580


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 Kursat Tigen, M.D.,* Selcuk Pala, M.D.,† Beste Ozben Sadic, M.D.,* Tansu Karaahmet, M.D.,‡ Cihan Dundar, M.D.,† Mustafa Bulut, M.D.,† Akin Izgi, M.D.,† Ali Metin Esen, M.D.,† and Cevat Kirma, M.D.† *Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey; †Department of Cardiology, Kartal Kosuyolu Heart Training and Research Hospital, Istanbul, Turkey; and ‡Department of Cardiology, Acibadem University School of Medicine, Istanbul, Turkey

Background: Severe mitral stenosis (MS) may impair left atrial (LA) pump function, and increase LA and pulmonary venous pressure resulting in right ventricular (RV) systolic dysfunction. The aim of this study was to evaluate biventricular and LA function after percutaneous mitral balloon valvuloplasty (PMBV) by tissue Doppler (TDI) and speckle tracking echocardiography (STE). Methods: Twenty-eight consecutive patients with severe symptomatic rheumatic MS (11 men, mean age: 39  7 years) who were referred for PMBV were included in the study. In addition to conventional echocardiography, all patients underwent TDI and two-dimensional (2D) (STE) to assess left ventricular (LV), LA, and RV function before and 3 months after PMBV. Severity of mitral regurgitation (MR) was graded by the ratio of MR jet area to LA area (JA/LAA) method and any postprocedural progression of the JA/LAA ratio was defined as worsening of MR. Peak systolic velocity of tricuspid lateral annulus (RVs) 50% luminal stenosis in any coronary artery detected by coronary angiography), permanent pacemaker, and chronic kidney disease (patients with >stage 3 chronic kidney disease) were excluded from the study. Percutaneous mitral commissurotomy was performed using Inoue technique as previously described, and pre- and postprocedural LA pres-


sures were recorded.16 The investigation conforms to the principles outlined in the Declaration of Helsinki. The study was approved by the local ethics committee. Written informed consent was obtained from each participant included in the study. Echocardiographic Evaluation: Echocardiographic studies were performed with a Vivid 7 (GE Vingmed Ultrasound AS, Horten, Norway) by a single experienced cardiologist before and 3 months after PMBV. Data acquisition was performed with a 3.5 MHz transducer at a depth of 16 cm in parasternal and apical views (standard parasternal short-axis from midventricular level, apical long-axis, two-chamber and four-chamber images). Standard M-mode, 2D and color-coded TDI images were obtained during breath-hold, stored in cine loop format from 3 consecutive beats and transferred to a workstation for further offline analysis (EchoPAC 6.1; GE Vingmed Ultrasound AS). Gain settings, filters, and pulse repetitive frequency were adjusted to optimize color saturation, and a color Doppler frame scanning rate of 100–140 Hz was used for color TDI images. Chamber dimensions and volumes were measured according to the guidelines of the American Society of Echocardiography, and LV EF was calculated by biplane Simpson’s method.17 LA volume index was calculated as previously described.17 MVA and gradients were calculated according to the guideline recommendations.18 Quantification of MR was performed using the proximal isovelocity surface area method.19 Severity of MR was graded by the ratio of MR jet area to left atrial area (JA/LAA) method.20 MR was considered mild when the regurgitant JA occupied >5% and 20% and 40% of the LAA. Any postprocedural progression of the JA/LAA ratio was defined as worsening of MR. Pulmonary artery systolic pressure (PAPs) was estimated using the Bernoulli equation (by adding RV systolic pressure determined from peak tricuspid regurgitant velocity to estimated RA pressure).21 Tricuspid annular plane systolic excursion (TAPSE) was calculated as previously described.22 Conventional color-coded TDI was performed for detailed assessment of regional myocardial function (EchoPac 6.1, GE Medical Systems, Horten, Norway). For detailed assessment of regional myocardial function, the sampling window was placed at the myocardial segment of interest. In the apical four-chamber view, LV septal and lateral walls were assessed from basal levels. To assess global cardiac function, the myocardial

Biventricular and Left Atrial Functions after PMBV

sustained systolic (s), early diastolic (e), and late diastolic (a) velocities from the basal septal and lateral LV walls were calculated. Sample volume was placed at the lateral tricuspid annular area, and tricuspid annular peak systolic velocity (RVs) was measured to assess RV systolic function. RVs

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.

Severe mitral stenosis (MS) may impair left atrial (LA) pump function, and increase LA and pulmonary venous pressure resulting in right ventricular (R...
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