Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation.
Left ventricular dyssynchrony; Mitral regurgitation; Exercise; 3D echocardiography
Abstract :
[en] Aims: Left ventricular (LV) shape and LV dyssynchrony are two cofactors associated with functional mitral regurgitation (MR) in patients with heart failure. Both can be accurately examined by real-time three-dimensional echocardiography (3DE). We examined the relationship between dynamic MR and exercise-induced changes in LV shape and synchronicity using 3DE.
Methods and results: Fifty patients with systolic LV dysfunction underwent 2D and 3D quantitative assessment of LV function, shape, and synchronicity at rest and during symptom-limited exercise test. According to the magnitude of change in MR, patients were divided into EMR group (15 patients, 30%), if the degree of MR increased during test, and NEMR group. During exercise, the changes in LV volumes and ejection fraction were similar in both groups, whereas changes in mitral valvular deformation parameters, in LV sphericity index, and in the extent of LV dyssynchrony were more pronounced in the EMR group. At rest, only the 3D sphericity index could distinguish the two groups. By stepwise multiple regression model, dynamic changes in the systolic dyssynchrony index, sphericity index, and coaptation distance were associated with dynamic MR (r2 = 0.45, P = 0.012).
Conclusion: Dynamic MR during exercise is related to the 3D changes in LV shape and in LV synchronicity.
Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation.
Sullivan MJ, Knight D, Higginbotham MB, Cobb FR. Relation between central and peripheral hemodynamics during exercise in patients with chronic heart failure: muscle blood flow is reduced with maintenance of arterial perfusion pressure. Circulation 1989;80:769-781
Higginbotham MB, Morris KG, Williams RS, McHale PA, Coleman RE, Cobb FR. Regulation of stroke volume during submaximal and maximal upright exercise in normal man. Circ Res 1986;58:281-291
Higginbotham MB, Morris KG, Conn EH, Coleman RE, Cobb FR. Determinants of variable exercise performance among patients with severe left ventricular dysfunction. Am J Cardiol 1983;51:52-60.
Ballester M, Jajoo J, Rickards A, McDonald L. The mechanism of mitral regurgitation in dilated left ventricle. Clin Cardiol 1983;6:333-338
Tanabe K, Ishibashi Y, Ohta T, Oyake N, Shimada T, Murakami R et al. Effect of left and right lateral decubitus positions on mitral flow pattern by Doppler echocardiography in congestive heart failure. Am J Cardiol 1993;71:751-753
Stevenson LW, Brunken RC, Belil D, Grover-MacKay M, Schwaiger M, Schelbert HR et al. Afterload reduction with vasodilators and diuretics decreases mitral regurgitation during upright exercise in advanced heart failure. J Am Coll Cardiol 1990;15:174-180
Stevenson LW, Bellil D, Grover-McKay M, Brunken RC, Schwaiger M, Tillisch JH et al. Effects of afterload reduction (diuretics and vasodilators) on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1987;60:654-658
Karen G, LeJemtel TH, Zelcer AA, Meisner JS, Bier A, Yellin EL. Time variation of mitral regurgitant flow in patients with dilated cardiomyopathy. Circulation 1986;74:684-692
Lapu-Bula R, Robert A, Van Craeynest D, D'Hondt AM, Gerber BL, Pasquet A et al. Contribution of exercise-induced mitral regurgitation to exercise stroke volume and exercise capacity in patients with left ventricular systolic dysfunction. Circulation 2002;106:1342-1348
Lancellotti P, Stainier P-Y, Lebois F, Pierard LA. Effect of dynamic left ventricular dyssynchrony on mitral regurgitation in patients with heart failure due to coronary artery disease. Am J Cardiol 2005;96:1304-1307
Lancellotti P, Troisfontaines P, Toussaint AC, Pierard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation 2003;108: 1713-1717 (Pubitemid 37243659)
Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 1970;2:92-98
Boltwood CM, Tei C, Wong M, Shah PM. Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation. Circulation 1983;68:498-508.
Mannaerts HF, Van Der Heide JA, Kamp O, Stoel MG, Twisk J, Visser CA. Early identification of left ventricular remodeling after myocardial infarction, assessed by transthoracic 3D echocardiography. Eur Heart J 2004;25:680-687
Takeuchi M, Jacobs A, Sugeng L, Nishikage T, Nakai H, Weinert L et al. Assessment of left ventricular dyssynchrony with real-time 3-dimensional echocardiography: comparison with Doppler tissue imaging. J Am Soc Echocardiogr 2007;20:1321-1329
Giga V, Ostojic M, Vujisic-Tesic B, Djordjevic-Dikic A, Stepanovic J, Beleslin B et al. Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape. Eur Heart J 2005;26:1860-1865
Lafitte S, Bordachar P, Lafitte M, Garrigue S, Reuter S, Reant P et al. Dynamic ventricular dyssynchrony. An exercise-echocardiography study. J Am Coll Cardiol 2006;47:2253-2259
Yu C, Abraham WT, Bax J, Chung E, Fedewa M, Ghio S et al. Predictors of response to cardiac resynchronization therapy (PROSPECT)-study design. Am Heart J 2005;149:600-605
Monaghan MJ. Role of real time 3D echocardiography in evaluating the left ventricle. Heart 2006;92:131-136
Ennezat PV, Maréchaux S, Le Tourneau T, Lamblin N, Bauters C, Van Belle E et al. Myocardial asynchronism is a determinant of changes in functional mitral regurgitation severity during dynamic exercise in patients with chronic heart failure due to severe left ventricular systolic dysfunction. Eur Heart J 2006;27:679-683
Ypenburg C, Lancellotti P, Tops LF, Boersma E, Bleeker GB, Holman ER et al. Mechanism of improvement in mitral regurgitation after cardiac resynchronization therapy. Eur Heart J 2008;29:757-765
Peteiro P, Pinon R, Perez L, Monserrat D, Perez A. Comparison of 2- and 3-dimensional exercise echocardiography for the detection of coronary artery disease. J Am Soc Echocardiogr 2007;8:959-967
