ABSTRACT
BACKGROUND: Mitral annular disjunction (MAD) tends to coexist with mitral valve prolapse (MVP) and mitral regurgitation (MR), and is also highly associated with arrhythmias. Myocardial work (MW) analysis is dedicated to estimate myocardial performance by integrating strain analysis and afterload. We aimed to use MW analysis to investigate the cardiac remodeling and dysfunction in MAD, particularly the damage of some segments, and to enhance the understanding of the correlations between MW parameters and VAs within MVP patients. METHODS: A total of 22 consecutive MVP patients with MAD (MAD+) and 44 consecutive MVP patients without MAD (MAD-) (50 ± 11yeas; 18% females) were screened by propensity score matching (PSM), and were divided into subgroups based on MR severity (MR+: Grade 2+; MR-: ≤1), GWI median (GWI ≤ 2079.5 mmHg%; GWI>2079.5 mmHg%), as well as the presence of VAs (VAs+; VAs-). MW parameters consist of global work efficiency (GWE), global work index (GWI), global constructive work (GCW) and global wasted work (GWW). RESULTS: The MAD+ patients had larger LVEDD and LAVI, as well as lower GWE, GWI, and GCW (all P<0.05) compared to the MAD- patients, regardless of similar GLS and regurgitant volume(both P>0.05). When categorized by MR severity, GWI (P = 0.049) and GCW (P = 0.040) were diminished in the MR-MAD+ group. The regional analysis showed MAD+ patients had decreased MW index in the basal (posterior and inferior) and mid (posterior and inferior) segments. Multivariate linear regression showed MAD phenotype, but not MR severity, was independently associated with diminished GWE, GWI, and GCW (all P<0.05). When divided by GWI median, MAD phenotype [OR (95%CI): 5.189 (1.193-22.572), P = 0.028] was an independent predictor of decreased GCW. The receiver-operating characteristic curve identified bileaflet prolapse [AUC (95%CI): 0.664 (0.502-0.825), P = 0.045], and GWI for basal inferior [(AUC (95%CI): 0.679 (0.538-0.819), P = 0.020] as the predictors of the VAs. CONCLUSION: MAD phenotype has the ability to compromise cardiac structure and function, irrespective of volume overload, as evidenced by dilated LV and impaired MW index in basal and mid segments. Excessively decreased regional MW index can identify patients with the high risk of VAs. MW analysis can be a valuable imaging marker for detecting myocardial impairment induced by MAD.
ABSTRACT
The prompt and precise identification of hemodynamically significant coronary artery lesions remains an ongoing challenge. This study investigated the diagnostic value of non-invasive global left ventricular myocardial work indices by echocardiography in functional status of coronary artery disease (CAD) patients with myocardial ischemia using fractional flow reserve (FFR) as the gold standard. A total of 77 consecutive patients with clinically suspected CAD were prospectively enrolled. All participants sequentially underwent echocardiography, invasive coronary angiography (ICA) and FFR measurement. According to the results of ICA, patients were divided into myocardial ischemia group (FFR ≤ 0.8, n = 27) and non-myocardial ischemia group (FFR > 0.8, n = 50). Myocardial work indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE), global positive work (GPW), global negative work (GNW), global systolic constructive work (GSCW) and global systolic wasted work (GSWW) were obtained by using the non-invasive left ventricular pressure strain loop (PSL) technique. Compared with the non-myocardial ischemia group, GWI, GCW, GPW and GSCW were significantly decreased in the myocardial ischemia group at either the 18-segment level or the 12-segment level (P < 0.001). At the 18-segment level, GWI < 1783.6 mmHg%, GCW < 1945.4 mmHg%, GPW < 1788.7 mmHg% and GSCW < 1916.5 mmHg% were optimal cut-off value to detect myocardial ischemia with an FFR ≤ 0.8. Global left ventricular myocardial work indices by echocardiography exhibited a good diagnostic value in patients with CAD and may have a good clinical significance for the screening of suspected myocardial ischemia.
ABSTRACT
BACKGROUND: There is limited data on the 2-year outcomes of transapical transcatheter edge-to-edge repair (TA-TEER) using the ValveClamp in patients with severe primary mitral regurgitation (MR) and its impact on myocardial deformation. METHODS: From July 2018 to March 2021, 53 patients with symptomatic severe primary MR underwent TA-TEER were enrolled. The endpoint was the composite of all-cause mortality, recurrent 3 + or 4 + MR, or need for mitral surgery. RESULTS: Among the 53 patients who had successfully ValveClamp implantation, 8(15.1%) reached the composite endpoint. Significant improvement in left ventricular (LV) end-diastolic volume, pulmonary artery systolic pressure, NYHA functional class, and MR severity were observed (P < 0.05 for all). Univariate Cox's regression analysis revealed that LV end-diastolic volume index, LV end-systolic volume index, left atrial volume index, and pulmonary artery systolic pressure were associated with adverse events (P < 0.05 for all). On multivariate Cox regression analysis, left atrial volume index was independently associated with the endpoint (hazard ratio, 1.049; 95% CI, 1.009-1.091; P < 0.001) after adjustment for above echocardiographic parameters. LV global longitudinal strain and apical longitudinal strain in global and regional segments decreased at 30 days, but showed a recovery at 2 years with no significant difference compared to the baseline. CONCLUSION: TA-TEER using the ValveClamp presented favorable safety and efficacy at 2-year. Myocardial deformation impairment was observed at 30 days post-procedure, but did not persist at 2 years.