Project description:IntroductionVolume overload from mitral regurgitation can result in left ventricular systolic dysfunction. To prevent this, it is essential to operate before irreversible dysfunction occurs, but the optimal timing of intervention remains unclear. Current echocardiographic guidelines are based on 2D linear measurement thresholds only. We compared volumetric CT-based and 2D echocardiographic indices of LV size and function as predictors of post-operative systolic dysfunction following mitral repair.MethodsWe retrospectively identified patients with primary mitral valve regurgitation who underwent repair between 2005 and 2021. Several indices of LV size and function measured on preoperative cardiac CT were compared with 2D echocardiography in predicting post-operative LV systolic dysfunction (LVEFecho <50%). Area under the curve (AUC) was the primary metric of predictive performance.ResultsA total of 243 patients were included (mean age 57 ± 12 years; 65 females). The most effective CT-based predictors of post-operative LV systolic dysfunction were ejection fraction [LVEFCT; AUC 0.84 (95% CI: 0.77-0.92)] and LV end systolic volume indexed to body surface area [LVESViCT; AUC 0.88 (0.82-0.95)]. The best echocardiographic predictors were LVEFecho [AUC 0.70 (0.58-0.82)] and LVESDecho [AUC 0.79 (0.70-0.89)]. LVEFCT was a significantly better predictor of post-operative LV systolic dysfunction than LVEFecho (p = 0.02) and LVESViCT was a significantly better predictor than LVESDecho (p = 0.03). Ejection fraction measured by CT demonstrated significantly greater reproducibility than echocardiography.DiscussionCT-based volumetric measurements may be superior to established 2D echocardiographic parameters for predicting LV systolic dysfunction following mitral valve repair. Validation with prospective study is warranted.
Project description:Secondary or functional mitral regurgitation (FMR) represents an increasing feature of mitral valve disease characterized by abnormal function of anatomically normal leaflets in the context of the impaired function of remodelled left ventricles. The anatomic and pathophysiological basis of FMR are briefly analyzed; in addition, the role of exercise echocardiography for the assessment of FMR is discussed in view of its relevance to clinical practice.
Project description:The risk of left ventricular (LV) and right ventricular (RV) maladaptation after surgery for isolated primary mitral regurgitation (PMR) is poorly defined. We aimed to evaluate LV and RV contractile function using speckle-tracking analysis alongside with quantification of exercise tolerance in patients with PMR after mitral valve surgery. All consecutive patients with symptomatic PMR undergoing mitral valve surgery between July 2015 and May 2017 were prospectively enrolled. Sequential echocardiographic studies along with clinical assessment were performed before and three months after surgery. Mean age in 138 patients was 65.8 ± 12.7 years, 48.2% (66) of whom were female. Mean LV ejection fraction decreased from 57 ± 12% to 50 ± 11% (p < 0.001), LV global longitudinal strain deteriorated from -19.2 ± 4.1% to -15.7 ± 3.8% (p < 0.001), and mechanical strain dispersion increased from 88 ± 12 to 117 ± 115 ms (p = 0.004). There was a reduction in tricuspid annulus plane systolic excursion from 22 ± 5 mm to 18 ± 4 mm (p < 0.001), as well as a slight deterioration of RV free wall mean longitudinal strain from -16.9 ± 5.6% to -15.7 ± 4.1% (p = 0.05). The rate of moderate to severe tricuspid regurgitation significantly decreased (p < 0.005). Regarding exercise tolerance, the New York Heart Association class improved (p < 0.001) and the walking distance increased (p < 0.001). During mid-term follow up after surgery for PMR, a deterioration of LV and RV contractile function measures could be observed. However, the clinical status, LV dimensions, and concomitant tricuspid regurgitation improved which in particular imply more effective RV contractile pattern.
Project description:Mitral regurgitation is the second most prevalent valvular disease, with primary mitral regurgitation (PMR) accounting for 61%-67% of cases. Chronic PMR can result in progressive left ventricular remodeling and dysfunction, ultimately leading to heart failure or other adverse cardiac events. This, in turn, necessitates frequent referrals, hospitalizations, and cardiac surgeries. The optimal timing for PMR surgery has been a subject of ongoing debate and remains a controversial issue. Presently, it is recommended that patients with chronic PMR undergo earlier mitral valve surgery to enhance post-operative outcomes. For example, the recommendation of European and American guidelines about left ventricular end-systolic diameter for surgery has been altered from 45 mm to 40 mm. Echocardiographic parameters are regarded as noteworthy indicators for intervention in patients with PMR. Extensive research has been undertaken in the field of echocardiography to identify more effective indicators that can propose the optimal timing for surgery, encompassing both conventional and novel echocardiography parameters. However, some parameters are not known to clinicians and the cut-off values for these parameters have shown some variations. Furthermore, a comprehensive review of this topic is currently missing. Consequently, this review aims to provide a thorough summary and elucidation of the prognostic significance of various echocardiographic measurements and their corresponding cut-off values, to help the clinical decision-making and further improve the outcomes of patients with PMR.
Project description:BackgroundMitral regurgitation (MR) is the most common form of valvular heart disease (VHD), and the accurate assessment of MR severity is critical for clinical management. However, the quantitative assessment of MR is intricate and time-consuming, posing challenges for physicians in ensuring the precision of the results. Thus, our objective was to create an automated and reproducible artificial intelligence (AI) system. This study aimed to assist physicians in grading MR severity using color Doppler echocardiograms through the implementation of a fully convolutional neural network (FCN).MethodsA retrospective cohort was established comprising 433 patients diagnosed with MR based on clinical criteria. Following screening, 269 patients met the inclusion criteria for the study. In total, 4,104 frames from apical 4-chamber view color Doppler flow images constituted the training and validation set, while 1,060 frames comprised the test set. Using the FCN, the MR flow convergence region was captured and segmented. The algorithm also estimated the parameter radius, which was employed to compute the effective regurgitant orifice area (EROA) and regurgitant volume (RV) based on the proximal isovelocity surface area. These measurements were subsequently graded following the 2017 American Society of Echocardiography (ASE) guidelines. The segmentation and grading performance of the model were assessed. Additionally, the diagnostic performance of the AI model was compared to that of ultrasound physicians with varying years of experience.ResultsIn groups I, II, III, and IV, the rates of correctly identifying the radius were 0.56, 0.83, 0.86, and 0.89, while the grading accuracy was 0.95, 0.89, 0.88, and 0.91, respectively. Regarding patients with MR of different etiologies, the grading accuracy for the functional MR and degenerative MR groups was 0.82 and 0.90, respectively. Using Carpentier classification of MR as the criterion, the accuracy for groups I, II, and IIIb was 0.80, 0.90, and 0.83, respectively.ConclusionsThe model showed commendable performance, streamlining the clinical diagnostic process and enhancing the precision and stability of quantitative MR assessment.