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. 2015 Aug 17:2:31.
doi: 10.3389/fcvm.2015.00031. eCollection 2015.

Mitral Annular Kinetics, Left Atrial, and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation

Chun G Schiros  1 , Mustafa I Ahmed  1 , David C McGiffin  2 , Xiaoxia Zhang  3 , Steven G Lloyd  4 , Inmaculada Aban  5 , Thomas S Denney Jr  3 , Louis J Dell'Italia  4 , Himanshu Gupta  4
Affiliations

Mitral Annular Kinetics, Left Atrial, and Left Ventricular Diastolic Function Post Mitral Valve Repair in Degenerative Mitral Regurgitation

Chun G Schiros et al. Front Cardiovasc Med. .

Abstract

Objective: The relationship of mitral annular (MA) kinetics to left ventricular (LV) and left atrial (LA) function before and after mitral valve (MV) repair has not been well studied. Here we sought to provide comprehensive analysis that relates to MA motions, and LA and LV diastolic function post MV repair.

Methods: Three-dimensional analyses of mitral annular motion, LA function, and LV volumetric and diastolic strain rates were performed on 35 degenerative mitral regurgitation (MR) patients at baseline and 1-year post MV repair, and 51 normal controls, utilizing cardiac magnetic resonance imaging with tissue tagging.

Results: All had normal LV ejection fraction (EF) at baseline. LV and LA EFs decreased 1-year post-surgery vs. controls. LV early diastolic myocardial strain rates decreased post-surgery along with decreases in normalized early diastolic filling rate, E/A ratio, and early diastolic MA relaxation rates. Post-surgical LA late active kick remained higher in MR patients vs. control. LV and LA EFs were significantly associated with peak MA centroid to apex shortening. Furthermore, during LV systolic phase, peak LV ejection and LA filling rates were significantly correlated with peak MA centroid to apex shortening rate, respectively. While during LV diastolic phase, both peak early diastolic MA centroid to apex relaxation rate and LA ejection rate were positively significantly associated with LV peak early diastolic filling rate.

Conclusion: MA motion is significantly associated with LA and LV function. Mitral annular motion, left atrial function, and LV diastolic strain rates are still impaired 1 year post MV repair. Long-term effects of these impairments should be prospectively evaluated.

Keywords: isolated mitral regurgitation; left atrial function; left ventricular diastolic function; mitral annular kinetics; mitral valve repair.

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Figures

Figure 1
Figure 1
Left ventricular volume-time curves for the control group and MR group at baseline and 12 months after surgery. Data are mean ± SE. Ejection rate and early filling rate are decreased in MR 1 year after surgery.
Figure 2
Figure 2
Two-dimensional circumferential strain vs. time curves (A) and torsion shear angle vs. time curves (B) in control vs. MR before and after surgery. One year after surgery, MR patients demonstrate a decrease in circumferential strain relaxation rate as represented by a flatter curve during early diastole.
Figure 3
Figure 3
Representative MR LV end-diastolic and end-systolic 4 chamber view (top) and 2 chamber view (bottom) before and after surgery. The mitral annulus septal lateral diameter as well as the transverse diameter is reduced after surgery. Up triangle: basal septal; down triangle: basal lateral; + : basal anterior; *: basal inferior. ED: end-diastole; ES: end-systole.
Figure 4
Figure 4
Mitral annular centroid to apex shortening (in mm) vs. time curves in control vs. MR before and after surgery. One year after surgery, MR patients demonstrate a decrease in mitral annulus mechanics compared with control. MA, mitral annulus; C, centroid; A, apex; Dist, distance; Disp, displacement. Data are mean ± SE.
Figure 5
Figure 5
Left atrial volume-time curves for the control group and MR group at baseline and 12 months after surgery. Data are mean ± SE.
See this image and copyright information in PMC

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