Vol. 19 No. 1 (2015)
ISCHEMIC MITRAL INSUFFICIENCY

Systolic longitudinal strain and congestive heart failure in patients with moderate ischemic mitral insufficiency before and after surgical revascularization and mitral annuloplasty

PDF (Русский)
  • S. Sukhanov,
  • Ye. Orekhova,
  • I. Naumenko,
  • T. Matanovskaya
S. Sukhanov
Federal Center of Cardiovascular Surgery
Bio
Ye. Orekhova
Federal Center of Cardiovascular Surgery
Bio
I. Naumenko
Federal Center of Cardiovascular Surgery
Bio
T. Matanovskaya
Federal Center of Cardiovascular Surgery
Bio
DOI: https://doi.org/10.21688/1681-3472-2015-1-43-50

Published 2015-10-10

Keywords

  • ISCHEMIC MITRAL REGURGITATION,
  • HEART FAILURE,
  • LONGITUDINAL STRAIN

How to Cite

Sukhanov, S., Orekhova, Y., Naumenko, I., & Matanovskaya, T. (2015). Systolic longitudinal strain and congestive heart failure in patients with moderate ischemic mitral insufficiency before and after surgical revascularization and mitral annuloplasty. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 19(1), 43–50. https://doi.org/10.21688/1681-3472-2015-1-43-50

Copyright (c) 2015 Sukhanov S.G., Orekhova Ye.N., Naumenko I.Ye., Matanovskaya T.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Objectives. The aim of this study was to evaluate the longitudinal systolic deformation indicators and the dynamics of chronic heart failure (HF) symptoms in patients before and after surgical revascularization and repair of ischemic mitral insufficiency.
Methods. We studied 65 patients after a myocardial infarction and a moderate degree of ischemic mitral regurgitation. The patients were divided into 2 groups: in the first group (n = 35) we performed isolated surgical revascularization (3.90.9 distal anastomosis), while the second group patients (n = 31) underwent combined coronary artery bypass grafting (3.61.3 distal anastomosis) and mitral annuloplasty. Before and after the operation (an average of 12 months after surgery) we evaluated the symptoms of heart failure, conventional ECG data, the indicators of systolic left ventricle (LV) longitudinal deformation and its rate (measured by using speckle-tracking 2-dimensional echocardiography). To obtain control ECG indicators, 25 healthy individuals were examined.
Results. Significant increases of the longitudinal systolic strain (before operation -6.72.9 %, after -8.73.8%, p=0.024) and strain rate (before operation -0.670.22 sec 1, after -0.770.21 sec 1, p=0.004) were observed only in the second group patients (combined surgical revascularization and mitral annuloplasty). Our results confirm that longitudinal systolic deformation is an objective quantitative indicator of left ventricular systolic function in patients with mitral insufficiency and an independent predictor of postoperative HF: GLPS -9.71.9% (95% CI from -9 to -10.4) associated with a decrease of functional class HF, GLPS -3.40.8 % (95% CI from -2.6 to -4.2) related with an increase of postoperative HF (=-0.9, RI=0.86).
Conclusions. In patients with moderate mitral regurgitation, the longitudinal myocardial strain and strain rate reflect a mechanical function of the left ventricle and predict heart failure after surgical revascularization.

PDF (Русский)

References

  1. Алехин М.Н. Ультразвуковые методы оценки деформации миокарда и их клиническое значение. М.: Издательский дом Видар-М, 2012. 88 с.
  2. Струтынский А.В. Эхокардиограмма: анализ и интерпретация. М.: МЕДпресс-информ, 2001. 208 с.
  3. Abraham T.P., Nishimura R.A. Myocardial Strain: Can we Finally Measure Contractility? // J. Am. Coll. Cardiol. 2001. Vol. 37 (3). P. 731-34.
  4. Borg A.N., Harrison J.L., Argyle R.A. Left ventricular filling and diastolic myocardial deformation in chronic primary mitral regurgitation // Eur. J. Echocardiogr. 2010. Vol. 11 (6). P. 523-29.
  5. Chan K.M.J., Punjabi P.P., Flather M. Coronary Artery Bypass Surgery With or Without Mitral Valve Annuloplasty in Moderate Functional Ischemic Mitral Regurgitation. Final Results of the Randomized Ischemic Mitral Evaluation (RIME) Trial // Circulation. 2012. Vol. 126. P. 2502-10.
  6. Cheitlin M.D., Armstrong W.F., Aurigemma G.P. et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography) // J. Am. Soc. Echocardiogrt. 2003. Vol. 16 (10). P. 1091-110.
  7. Cho G.Y., Marwick T.H., Kim H.S. et.al. Global 2-dimention strain as a new prognosticator in patients with heart failure // J. Am. Coll. Cardiol. 2009. Vol. 54 (7). P. 618-24.
  8. Gillinov A.M., Wierup P.N., Blackstone E.H. et.al. Is repair preferable to replacement for ischemic mitral regurgitation? // J. Thorac. Cardiovasc. Surg. 2001. Vol. 122. P. 1125^1.
  9. Gorman R.C., Gorman J.H. III. Why should we repair ischemic mitral regurgitation? // Ann. Thorac. Surg. 2006. Vol. 81 (2). P. 785.
  10. Grigioni F., Enriquez-Sarano M., Zehr K.J. et.al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment // Circulation. 2001. Vol. 103. P. 1759-64.
  11. Guyatt G.H., Sullivan M.J., Thompson P.J. et al. The 6-min walk: a new measure of exercise capacity in patients with chronic heart failure // Can. Med. Assoc. J. 1985. Vol. 132. P. 919-23.
  12. Jones C.J.H., Raposo L., Gibson D.G. Functional important of the long axis dynamics of the human left ventricle // Br. Heart J. 1990. Garsia-Fernandez M.A., Zamorano J., Azevedo J. Doppler Tissue Imaging. McGRAW-HILL/INTERMEDICANA DE ESPANA, S.A.U. 1997. 155 p.
  13. Lamas G.A., Mitchell G.F., Flaker G.C. et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators // Circulation. 1997. Vol. 96. P. 827-3.
  14. Leitman M., Lysyansky P., Sidenko S. et al. Two-dimensional strain-a novel software for real-time quantitative echocardiographic assessment of myocardial function // J. Am. Soc. Echocardiogr. 2004. Vol. 17. P. 1021-29.
  15. Marwick T.H., Leano R.L., Brown. J. et al. Myocardial strain measurement with 2-dimentional speckle-tracking echocardiography: definition of normal range // J. Am. Coll. Cardiol. Cardiovasc. Imaging. 2009. Vol. 2 (1). P. 80-4.
  16. Neilan T.G., Ton-Nu T.T., Kawase Y. et al. Progressive nature of chronic mitral regurgitation and the role of tissue Doppler-derived indexes // Am. J. Physiol. Heart Circ. Physiol. 2008. Vol. 294. P. H 2106-11.
  17. Park S.J., Kang S.J., Song J.K. et al. Prognostic value of longitudinal strain after primary reperfusion therapy in patients with anteriorwall acute myocardial infarction // J. Am. Soc. Echocardiogr. 2008. Vol. 21. P. 262-67.
  18. Stoylen A., Skjaerpe T. Systolic long axis function of left ventricle. Global and regional information // Scand. Cardiovasc. J. 2003. Vol. 37 (5). P. 253-58.
  19. Zoghbi W.A., Enriquez-Sarano M., Foster E. et.al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography // J. Am. Soc. Echocardiogr. 2003. Vol. 16. P. 777-802.