Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation.

AIMS Chronic primary mitral regurgitation (MR) results in enhanced filling of the left ventricle (LV) during early diastole. Filling is impaired with the onset of LV systolic dysfunction, due to increased myocardial stiffness and reduced restoring forces. We investigated echocardiographic parameters of early diastolic function in relation to LV systolic function. METHODS AND RESULTS Early diastolic transmitral flow and tissue Doppler velocities, propagation velocity of early filling (V(p)), and early diastolic strain rates (SR-E) were measured in 30 patients with chronic degenerative MR and 30 age-matched controls. MR subjects were further subdivided into group 1 (14 subjects) if they had well compensated LV, and group 2 (16 subjects) if they had one or more of the following: functional limitation (> NYHA class I), LV end-systolic diameter >or=4.0 cm, and LV ejection fraction <or=60%. Group 1 had increased early diastolic transmitral flow and tissue velocities, V(p) and SR-E, compared with controls. V(p) and SR-E in group 2 (46.5 +/- 9.92 cm/s and 1.44 +/- 0.36 s(-1), respectively) decreased significantly compared with group 1 (74.4 +/- 19.9 cm/s and 1.96 +/- 0.53 s(-1), P <or= 0.002). Onset and peak of early long-axis expansion and myocardial lengthening were significantly delayed in MR, and this delay was directly correlated with preload parameters. CONCLUSION In chronic MR, novel echocardiographic measurements of early diastolic function exhibit a biphasic pattern depending on the state of LV systolic function, and may prove useful in the timing of surgery.

[1]  K. George,et al.  Interpretation of two-dimensional and tissue Doppler-derived strain (epsilon) and strain rate data: is there a need to normalize for individual variability in left ventricular morphology? , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[2]  Milind Y Desai,et al.  Impact of left ventricular volume/mass ratio on diastolic function. , 2009, European heart journal.

[3]  M. Jahangiri,et al.  Changes in systolic left ventricular function in isolated mitral regurgitation. A strain rate imaging study. , 2007, European heart journal.

[4]  A. Borg,et al.  Left ventricular torsion in primary chronic mitral regurgitation , 2007, Heart.

[5]  Jianwen Wang,et al.  Global Diastolic Strain Rate for the Assessment of Left Ventricular Relaxation and Filling Pressures , 2007, Circulation.

[6]  T. Abraham,et al.  Delayed Onset of Subendocardial Diastolic Thinning at Rest Identifies Hypoperfused Myocardium , 2005, Circulation.

[7]  Charles J Bruce,et al.  Ultrasound Strain Imaging of Altered Myocardial Stiffness: Stunned Versus Infarcted Reperfused Myocardium , 2004, Circulation.

[8]  G. Breithardt,et al.  Usefulness of tissue Doppler imaging for estimation of filling pressures in patients with primary or secondary pure mitral regurgitation. , 2004, The American journal of cardiology.

[9]  D. Khoury,et al.  Time interval between onset of mitral inflow and onset of early diastolic velocity by tissue Doppler: a novel index of left ventricular relaxation: experimental studies and clinical application. , 2003, Journal of the American College of Cardiology.

[10]  R. Levine,et al.  Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. , 2003, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[11]  W. Little,et al.  Diastolic mitral annular velocity during the development of heart failure. , 2003, Journal of the American College of Cardiology.

[12]  Gianni Pedrizzetti,et al.  Fluid dynamics of the left ventricular filling in dilated cardiomyopathy. , 2002, Journal of biomechanics.

[13]  N. Ohte,et al.  Striking effect of left ventricular high filling pressure with mitral regurgitation on mitral annular velocity during early diastole. A study using colour M-mode tissue Doppler imaging. , 2002, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[14]  Mario J. Garcia,et al.  Estimation of diastolic intraventricular pressure gradients by Doppler M-mode echocardiography. , 2001, American journal of physiology. Heart and circulatory physiology.

[15]  M. Cicoira,et al.  Mitral regurgitation and left ventricular diastolic dysfunction similarly affect mitral and pulmonary vein flow Doppler parameters: the advantage of end-diastolic markers. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[16]  N. Ohte,et al.  Evaluation of left ventricular early diastolic performance by color tissue Doppler imaging of the mitral annulus. , 1998, The American journal of cardiology.

[17]  Mario J. Garcia,et al.  New Doppler echocardiographic applications for the study of diastolic function. , 1998, Journal of the American College of Cardiology.

[18]  M. Quiñones,et al.  Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. , 1997, Journal of the American College of Cardiology.

[19]  D. Brutsaert,et al.  Diastolic dysfunction in heart failure. , 1997, Journal of cardiac failure.

[20]  H. C. Kim,et al.  Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. , 1997, Journal of the American College of Cardiology.

[21]  A. Parisi,et al.  Effects of left ventricular systolic function on left ventricular diastolic filling patterns in severe mitral regurgitation. , 1997, The American journal of cardiology.

[22]  Mario J. Garcia,et al.  An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. , 1997, Journal of the American College of Cardiology.

[23]  R Beyar,et al.  Effects of load manipulations, heart rate, and contractility on left ventricular apical rotation. An experimental study in anesthetized dogs. , 1995, Circulation.

[24]  M. Zile,et al.  Changes in Diastolic Function During Development and Correction of Chronic LV Volume Overload Produced by Mitral Regurgitation , 1993, Circulation.

[25]  P. Ludbrook,et al.  Factors Related to End‐Systolic Volume Are Important Determinants of Peak Early Diastolic Transmitral Flow Velocity , 1992, Circulation.

[26]  I. Mirsky,et al.  Effects of left ventricular volume overload produced by mitral regurgitation on diastolic function. , 1991, The American journal of physiology.

[27]  O. Hess,et al.  Left Ventricular Passive Diastolic Properties in Chronic Mitral Regurgitation , 1991, Circulation.

[28]  P. Ludbrook,et al.  Physiological early diastolic intraventricular pressure gradient is lost during acute myocardial ischemia. , 1990, Circulation.

[29]  A. Weyman,et al.  Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. , 1988, Circulation.

[30]  T. Wisenbaugh,et al.  Does normal pump function belie muscle dysfunction in patients with chronic severe mitral regurgitation? , 1988, Circulation.

[31]  K. Peterson,et al.  Early diastolic filling dynamics during experimental mitral regurgitation in the conscious dog. , 1987, Circulation.

[32]  M. Quiñones,et al.  Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. , 1986, Journal of the American College of Cardiology.

[33]  A. Bove,et al.  Use of left ventricular filling and ejection patterns in assessing severity of chronic mitral and aortic regurgitation. , 1984, The American journal of cardiology.

[34]  K. Cohn,et al.  Echocardiographic Assessment of the Level of Cardiac Compensation in Valvular Heart Disease , 1976, Circulation.

[35]  M. Jahangiri,et al.  Myocardial deformation abnormalities in patients with aortic regurgitation: a strain rate imaging study. , 2009, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[36]  Mario J. Garcia,et al.  Determinants of diastolic myocardial tissue Doppler velocities: influences of relaxation and preload. , 2001, Journal of applied physiology.

[37]  D. Khoury,et al.  Hemodynamic determinants of the mitral annulus diastolic velocities by tissue Doppler. , 2001, Journal of the American College of Cardiology.

[38]  Mario J. Garcia,et al.  Color M-mode Doppler flow propagation velocity is a preload insensitive index of left ventricular relaxation: animal and human validation. , 2000, Journal of the American College of Cardiology.

[39]  H. Spotnitz,et al.  Systolic and diastolic properties of the human left ventricle during valve replacement for chronic mitral regurgitation. , 1981, The American journal of cardiology.