Reduction in mitral regurgitation in patients undergoing cardiac resynchronization treatment: Assessment of predictors by two-dimensional radial strain echocardiography

Sorel Goland, Asim M. Rafique, James Mirocha, Robert J. Siegel, Tasneem Zehra Naqvi

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: We utilized the novel approach of 2D radial strain (2-DRS) to evaluate whether left ventricular (LV) mechanical dyssynchrony in mid-LV segments corresponding to papillary muscles insertion sites can predict early mitral regurgitation (MR) reduction post-cardiac resynchronization therapy (CRT). Methods: We evaluated 32 patients undergoing CRT (mean age 64 ± 17 years, 54% males) with MR grade ≥3 determined by the MR jet area/left atrial area ratio (JA/LAA). Results: Fifteen (47%) patients responded to CRT (JA/LAA) < 25%). Sixty-seven percent of responders had mild or no residual MR and 33% had mild-to-moderate MR, while 70% of nonresponders had grade 3 or 4 MR (P = 0.0001) post CRT. The percent reduction in LV end-systolic volume was significantly higher in responders (P = 0.03), as was improvement in LVEF (P = 0.007). Significant delay of time-to-peak 2-DRS in the midposterior and inferior segments prior to CRT was found in responders compared with nonresponders (580 ± 58 vs. 486 ± 94, P = 0.002 and 596 ± 79 vs. 478 ± 127 ms, P = 0.005, respectively). Responders also had higher peak positive systolic 2-DRS in the posterior and inferior segments compared to nonresponders (22 ± 13 vs. 12 ± 7%, P = 0.01 and 17 ± 9 vs. 9 ± 7%, P = 0.02, respectively). Logistic regression analysis showed that the differences in pre-CRT inferoanterior time-to-peak 2-DRS of >110 ms and MRJA/LAA <40% as well as 2-DRS >18% in the posterior wall were significant predictors of post-CRT improvement in MR. Conclusion: The presence of a significant time-to-peak delay on 2-DRS between inferior and anterior LV segments, preserved strain of posterior wall, and MRJA/LAA <40% were found to be associated with significant MR reduction in patients post-CRT.

Original languageEnglish (US)
Pages (from-to)420-430
Number of pages11
JournalEchocardiography
Volume26
Issue number4
DOIs
StatePublished - Apr 2009
Externally publishedYes

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Cardiac Resynchronization Therapy
Mitral Valve Insufficiency
Echocardiography
Therapeutics
Papillary Muscles

Keywords

  • Cardiac resynchronization
  • Mechanical dyssynchrony
  • Mitral regurgitation
  • Speckle-tracking echocardiography
  • Two-dimensional strain

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Reduction in mitral regurgitation in patients undergoing cardiac resynchronization treatment : Assessment of predictors by two-dimensional radial strain echocardiography. / Goland, Sorel; Rafique, Asim M.; Mirocha, James; Siegel, Robert J.; Naqvi, Tasneem Zehra.

In: Echocardiography, Vol. 26, No. 4, 04.2009, p. 420-430.

Research output: Contribution to journalArticle

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abstract = "Background: We utilized the novel approach of 2D radial strain (2-DRS) to evaluate whether left ventricular (LV) mechanical dyssynchrony in mid-LV segments corresponding to papillary muscles insertion sites can predict early mitral regurgitation (MR) reduction post-cardiac resynchronization therapy (CRT). Methods: We evaluated 32 patients undergoing CRT (mean age 64 ± 17 years, 54{\%} males) with MR grade ≥3 determined by the MR jet area/left atrial area ratio (JA/LAA). Results: Fifteen (47{\%}) patients responded to CRT (JA/LAA) < 25{\%}). Sixty-seven percent of responders had mild or no residual MR and 33{\%} had mild-to-moderate MR, while 70{\%} of nonresponders had grade 3 or 4 MR (P = 0.0001) post CRT. The percent reduction in LV end-systolic volume was significantly higher in responders (P = 0.03), as was improvement in LVEF (P = 0.007). Significant delay of time-to-peak 2-DRS in the midposterior and inferior segments prior to CRT was found in responders compared with nonresponders (580 ± 58 vs. 486 ± 94, P = 0.002 and 596 ± 79 vs. 478 ± 127 ms, P = 0.005, respectively). Responders also had higher peak positive systolic 2-DRS in the posterior and inferior segments compared to nonresponders (22 ± 13 vs. 12 ± 7{\%}, P = 0.01 and 17 ± 9 vs. 9 ± 7{\%}, P = 0.02, respectively). Logistic regression analysis showed that the differences in pre-CRT inferoanterior time-to-peak 2-DRS of >110 ms and MRJA/LAA <40{\%} as well as 2-DRS >18{\%} in the posterior wall were significant predictors of post-CRT improvement in MR. Conclusion: The presence of a significant time-to-peak delay on 2-DRS between inferior and anterior LV segments, preserved strain of posterior wall, and MRJA/LAA <40{\%} were found to be associated with significant MR reduction in patients post-CRT.",
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T1 - Reduction in mitral regurgitation in patients undergoing cardiac resynchronization treatment

T2 - Assessment of predictors by two-dimensional radial strain echocardiography

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AU - Rafique, Asim M.

AU - Mirocha, James

AU - Siegel, Robert J.

AU - Naqvi, Tasneem Zehra

PY - 2009/4

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N2 - Background: We utilized the novel approach of 2D radial strain (2-DRS) to evaluate whether left ventricular (LV) mechanical dyssynchrony in mid-LV segments corresponding to papillary muscles insertion sites can predict early mitral regurgitation (MR) reduction post-cardiac resynchronization therapy (CRT). Methods: We evaluated 32 patients undergoing CRT (mean age 64 ± 17 years, 54% males) with MR grade ≥3 determined by the MR jet area/left atrial area ratio (JA/LAA). Results: Fifteen (47%) patients responded to CRT (JA/LAA) < 25%). Sixty-seven percent of responders had mild or no residual MR and 33% had mild-to-moderate MR, while 70% of nonresponders had grade 3 or 4 MR (P = 0.0001) post CRT. The percent reduction in LV end-systolic volume was significantly higher in responders (P = 0.03), as was improvement in LVEF (P = 0.007). Significant delay of time-to-peak 2-DRS in the midposterior and inferior segments prior to CRT was found in responders compared with nonresponders (580 ± 58 vs. 486 ± 94, P = 0.002 and 596 ± 79 vs. 478 ± 127 ms, P = 0.005, respectively). Responders also had higher peak positive systolic 2-DRS in the posterior and inferior segments compared to nonresponders (22 ± 13 vs. 12 ± 7%, P = 0.01 and 17 ± 9 vs. 9 ± 7%, P = 0.02, respectively). Logistic regression analysis showed that the differences in pre-CRT inferoanterior time-to-peak 2-DRS of >110 ms and MRJA/LAA <40% as well as 2-DRS >18% in the posterior wall were significant predictors of post-CRT improvement in MR. Conclusion: The presence of a significant time-to-peak delay on 2-DRS between inferior and anterior LV segments, preserved strain of posterior wall, and MRJA/LAA <40% were found to be associated with significant MR reduction in patients post-CRT.

AB - Background: We utilized the novel approach of 2D radial strain (2-DRS) to evaluate whether left ventricular (LV) mechanical dyssynchrony in mid-LV segments corresponding to papillary muscles insertion sites can predict early mitral regurgitation (MR) reduction post-cardiac resynchronization therapy (CRT). Methods: We evaluated 32 patients undergoing CRT (mean age 64 ± 17 years, 54% males) with MR grade ≥3 determined by the MR jet area/left atrial area ratio (JA/LAA). Results: Fifteen (47%) patients responded to CRT (JA/LAA) < 25%). Sixty-seven percent of responders had mild or no residual MR and 33% had mild-to-moderate MR, while 70% of nonresponders had grade 3 or 4 MR (P = 0.0001) post CRT. The percent reduction in LV end-systolic volume was significantly higher in responders (P = 0.03), as was improvement in LVEF (P = 0.007). Significant delay of time-to-peak 2-DRS in the midposterior and inferior segments prior to CRT was found in responders compared with nonresponders (580 ± 58 vs. 486 ± 94, P = 0.002 and 596 ± 79 vs. 478 ± 127 ms, P = 0.005, respectively). Responders also had higher peak positive systolic 2-DRS in the posterior and inferior segments compared to nonresponders (22 ± 13 vs. 12 ± 7%, P = 0.01 and 17 ± 9 vs. 9 ± 7%, P = 0.02, respectively). Logistic regression analysis showed that the differences in pre-CRT inferoanterior time-to-peak 2-DRS of >110 ms and MRJA/LAA <40% as well as 2-DRS >18% in the posterior wall were significant predictors of post-CRT improvement in MR. Conclusion: The presence of a significant time-to-peak delay on 2-DRS between inferior and anterior LV segments, preserved strain of posterior wall, and MRJA/LAA <40% were found to be associated with significant MR reduction in patients post-CRT.

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KW - Mechanical dyssynchrony

KW - Mitral regurgitation

KW - Speckle-tracking echocardiography

KW - Two-dimensional strain

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