Assessment Of Left Ventricular Geometry And Function In Patients With Primary Mitral Regurgitation Using Three-dimensional Speckle Tracking Imaging

Part Ⅰ Assessment of left ventricular geometry and systolic function in patients with primary mitral regurgitation by three-dimensional speckle tracking imagingObjectives The aim of this study was to evaluate the changes of left ventricular(LV)geometry and systolic function in patients with chronic severe primary mitral regurgitation(PMR)by three-dimensional speckle tracking imaging(3D-STI)and to explore the relationship between the two.Methods Sixty-two patients diagnosed with chronic severe PMR and twenty healthy age-matched subjects were enrolled.The conventional parameters of left atrium diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)were acquired from traditional two-dimensional echocardiography(2DE).The data of left ventricular mass(LVM),sphericity index(SPI),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left ventricular ejection fraction(LVEF),as well as left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS)and global radial strain(GRS)were measured using 3D-STI.Then left ventricular remodeling index(LVRI)was calculated by the certain formula.The differences of all parameters between the groups were compared,and the relativity between the LV geometry index and the LV systolic function index was analyzed.Results(1)The comparison of LV geometry indices: LVEDD,LVESD,LVEDV,LVESV,LVM,SPI,LVRI in the PMR group were significantly higher than those in the control group(P < 0 05);(2)The comparison of LV systolic function indices: GAS,GRS in the PMR group were significantly lower than those in the control group(P < 0 05),while there were no significant difference in LVEF,GLS,GCS between groups(P>0.05).(3)There was a good negative one-to-one relationship between LV three-dimensional strain indices(GLS,GAS,GCS,GRS)and left ventricular configuration indices(LVEDD,LVESD,LVEDV,LVESV,LVM,LVRI,SPI)(P < 0.05).Conclusions In patients with chronic severe PMR,the spherical expansion of LV shape and the increase of LV mass,as well as the decrease of LV systolic function,were jointly involved in the LV pathological remodeling under the condition of LV chronic volume overload.There was a negative changing relation between LV systolic function and LV geometry in PMR patients.Part Ⅱ Parameters of 3D-STI to predict postoperative invalid left ventricular reverse remodeling in primary mitral regurgitationObjectives To quantitatively evaluate postoperative left ventricular reverse remodeling(LVRR)in patients with primary mitral regurgitation(PMR)by three-dimensional speckle tracking imaging(3D-STI)and to investigate the characteristic parameter for predicting invalid LVRR.Methods Forty-four patients with chronic severe PMR underwent mitral valve repair or mitral valve replacement were enrolled,with complete follow-up data.Traditional two-dimensional echocardiography and 3D-STI were performed on all patients at one day before surgery and the mid-postoperative term(defined as 10 to 12 months after surgery).A series of parameters of left atrium diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV),left ventricular ejection fraction(LVEF),left ventricular mass(LVM),sphericity index(SPI),as well as left ventricular global longitudinal strain(GLS),global circumferential strain(GCS),global area strain(GAS)and global radial strain(GRS)were acquired.According to the decrease of LVESV(△LVESV)postoperative mid-term,those patients were divided into two groups:valid LVRR group(Group A,△LVESV≥15%),and invalid LVRR group(Group B,△LVESV < 15%).The difference of each parameter was compared between the two groups.The characteristic parameter to predict postoperative left ventricular invalid reverse remodeling was identified by the multivariable logistic regression by stepwise methods,and the Receiver operating characteristic(ROC)curve was drawn to find the optimal cut-off value.Results(1)The comparison of conventional and 3D-STI parameters: compared with Group A,LAD,LVEDV in Group B were significantly increased,and GAS,GRS were significantly decreased(P<0.05);(2)The multivariable logistic regression analysis revealed that GAS(odds ratio [OR]=1.265,95% confidence interval was 0.95 to 1.68,P=0.023)was the only statistically significant independent predictor to predict invalid LVRR postoperative mid-term.The ROC curve indicated that the best cut-off point of GAS was-18.5%,the area under the curve(AUC)was 0.80,with a sensitivity of 62.5%,specificity 85.71%.Conclusions Parameters of 3D-STI may quantitative evaluate LVRR effects postoperative mid-term in patients with chronic severe PMR.Left ventricular global area strain was the independent predictor of invalid LVRR postoperative mid-term in PMR patients.