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. 2019 Feb;9(2):304-311.
doi: 10.21037/qims.2019.02.06.

Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects-Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

Zsolt Kovács  1 , Árpád Kormányos  2 , Péter Domsik  2 , Anita Kalapos  2 , Csaba Lengyel  3 , Nóra Ambrus  2 , Zénó Ajtay  4   5 , Györgyike Á Piros  2 , Tamás Forster  2 , Attila Nemes  2
Affiliations

Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects-Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

Zsolt Kovács et al. Quant Imaging Med Surg. 2019 Feb.

Abstract

Background: The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV strains, quantitative features of longitudinal contractility and MA size and function in healthy subjects.

Methods: The present study comprised 295 healthy adults; 117 subjects were excluded due to inferior image quality (40%). Finally, 178 healthy adults (mean age: 32.0±11.3 years, 92 males). Complete two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases.

Results: The global and mean segmental left ventricular longitudinal strain (LV-LS) proved to be -16.1%±2.5% and -16.9%±2.4%, respectively. In the present study, LV-LS ≤-13% was considered to be reduced. In ROC analysis, the cut-off value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity and 69% specificity and ROC area under curve 0.73 (P=0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤-13%. Significantly larger ratio of subjects with global LV-LS ≤-13% had MAFAC ≤44% (31% vs. 67%, P=0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤-13% (4% vs. 16%, P=0.009).

Conclusions: There is a strong relationship between MA and LV longitudinal function. MA fractional area change predicts global LV-LS.

Keywords: Healthy; echocardiography; left ventricular (LV); mitral annulus (MA); speckle-tracking; strain; three-dimensional.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
The apical four- (A) and two-chamber (B) views and 3 short-axis views at different left ventricular (LV) levels (C1, C2, C3) are presented in a healthy case. The three-dimensional LV cast (D) together with LV volumetric data (E) and LV segmental longitudinal strains (coloured lines) and LV volume-change (dashed line) regarding the cardiac cycle (F) are also presented. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
Figure 2
Figure 2
Images from three-dimensional full-volume echocardiographic dataset: apical four-chamber view (A), apical two-chamber view (B) and a cross-sectional view at the level of the mitral annulus (C3) optimized on apical four- and two-chamber views. (C1,C2) Cross-sectional views of different LV levels, not shown during MA measurements. Mitral annular data in end-systole and end-diastole are also presented. Area, MA area; Circ, MA perimeter; Dist, MA diameter; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.
Figure 3
Figure 3
Receiver operating characteristic analysis illustrating the diagnostic accuracy of mitral annular (MA) fractional area change (MAFAC) in predicting reduced (≤–13%) left ventricular longitudinal strain is demonstrated.
See this image and copyright information in PMC

References

    1. Dal-Bianco JP, Levine RA. Anatomy of the Mitral Valve Apparatus – Role of 2D and 3D Echocardiography. Cardiol Clin 2013;31:151-64. 10.1016/j.ccl.2013.03.001 - DOI - PMC - PubMed
    1. Zhang HM, Wang XT, Zhang LN, He W, Zhang Q, Liu DW, Chinese Critical Ultrasound Study Group Left Ventricular Longitudinal Systolic Function in Septic Shock Patients with Normal Ejection Fraction: A Case-control Study. Chin Med J (Engl) 2017;130:1169-74. 10.4103/0366-6999.205856 - DOI - PMC - PubMed
    1. Carasso S, Cohen O, Mutlak D, Adler Z, Lessick J, Reisner SA, Rakowski H, Bolotin G, Agmon Y. Differential effects of afterload on left ventricular long- and short-axis function: Insights from a clinical model of patients with aortic valve stenosis undergoing aortic valve replacement. Am Heart J 2009;158:540-5. 10.1016/j.ahj.2009.07.008 - DOI - PubMed
    1. Nemes A, Kalapos A, Domsik P, Forster T. Three-dimensional speckle-tracking echocardiography -- a further step in non-invasive three-dimensional cardiac imaging. Orv Hetil 2012;153:1570-7. 10.1556/OH.2012.29466 - DOI - PubMed
    1. Nemes A, Piros GÁ, Domsik P, Kalapos A, Lengyel C, Várkonyi TT, Orosz A, Forster T. Changes in mitral annular morphology and function in young patients with type 1 diabetes mellitus-results from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study. Quant Imaging Med Surg 2015;5:815-21. - PMC - PubMed