File Download
  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Mitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study

TitleMitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study
Authors
KeywordsMitral regurgitation
Atrial fibrillation
Three-dimensional echocardiography
Issue Date2019
PublisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/echo
Citation
Journal of The American Society of Echocardiography, 2019, v. 32 n. 4, p. 503-513 How to Cite?
AbstractBACKGROUND: Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS: Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS: The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS: In patients with AF and absent LA contraction, the normal predominantly 'atriogenic' annular dynamics become 'ventriculogenic.' Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. 'Atrial' functional MR may not be purely an atrial disorder.
Descriptioneid_2-s2.0-85060132429
Persistent Identifierhttp://hdl.handle.net/10722/272912
ISSN
2017 Impact Factor: 6.827
2015 SCImago Journal Rankings: 2.808

 

DC FieldValueLanguage
dc.contributor.authorTang, Z-
dc.contributor.authorFan, YT-
dc.contributor.authorWang, Y-
dc.contributor.authorJin, CN-
dc.contributor.authorKwok, KW-
dc.contributor.authorLee, APW-
dc.date.accessioned2019-08-06T09:18:55Z-
dc.date.available2019-08-06T09:18:55Z-
dc.date.issued2019-
dc.identifier.citationJournal of The American Society of Echocardiography, 2019, v. 32 n. 4, p. 503-513-
dc.identifier.issn0894-7317-
dc.identifier.urihttp://hdl.handle.net/10722/272912-
dc.descriptioneid_2-s2.0-85060132429-
dc.description.abstractBACKGROUND: Patients with atrial fibrillation (AF) and left atrial (LA) enlargement may develop functional, normal leaflet motion mitral regurgitation (MR) without left ventricular (LV) remodeling. Mitral annular dynamics and LV mechanics are important for preserving normal mitral valve function. The aim of this study was to assess the annular and LV dynamics in patients with AF and functional MR. METHODS: Twenty-one patients with AF with moderate or more MR (AFMR+ group), 46 matched patients with AF with no or mild MR (AFMR- group), and 19 normal patients were retrospectively studied. Mitral annular dynamics were quantitatively assessed using three-dimensional echocardiography. Systolic LV global longitudinal strain (GLS), global circumferential strain, and LA strain were measured using two-dimensional speckle-tracking echocardiography. RESULTS: The normal annulus displayed presystolic followed by systolic contraction and increase in saddle shape (P < .01 for all). Presystolic annular dynamics were abolished in both groups of patients with AF (P > .05 vs normal). In contrast, systolic and total annular dynamics during the cardiac cycle were preserved in AFMR- patients (P > .10 vs normal) but impaired in AFMR+ patients (P < .05 vs normal and AFMR-). LV GLS (P < .0001) and LA strain (P = .02), but not LV global circumferential strain (P = .97), were impaired in AFMR+ compared with AFMR- patients despite comparable LA and LV volumes. MR severity correlated with systolic annular contraction (r = 0.64, P < .0001), saddle deepening (r = 0.53, P = .003), and LV GLS (r = 0.46, P < .0001). Multivariate analysis identified that impaired systolic contraction (odds ratio, 2.18; P = .001) and saddle deepening (odds ratio, 2.68; P = .04) were independently associated with MR. Excluding annular dynamics from the model, less negative LV GLS, but not LA strain, became associated with MR (odds ratio, 1.93; P < .0001). CONCLUSIONS: In patients with AF and absent LA contraction, the normal predominantly 'atriogenic' annular dynamics become 'ventriculogenic.' Isolated LA enlargement is insufficient to cause important MR without coexisting abnormal LV mechanics and annular dynamics during systole. 'Atrial' functional MR may not be purely an atrial disorder.-
dc.languageeng-
dc.publisherMosby, Inc. The Journal's web site is located at http://www.elsevier.com/locate/echo-
dc.relation.ispartofJournal of The American Society of Echocardiography-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectMitral regurgitation-
dc.subjectAtrial fibrillation-
dc.subjectThree-dimensional echocardiography-
dc.titleMitral Annular and Left Ventricular Dynamics in Atrial Functional Mitral Regurgitation: A Three-Dimensional and Speckle-Tracking Echocardiographic Study-
dc.typeArticle-
dc.identifier.emailKwok, KW: kwokkw@hku.hk-
dc.identifier.authorityKwok, KW=rp01924-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1016/j.echo.2018.11.009-
dc.identifier.pmid30679142-
dc.identifier.hkuros300181-
dc.identifier.volume32-
dc.identifier.issue4-
dc.identifier.spage503-
dc.identifier.epage513-
dc.publisher.placeUnited States-

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats