ABSTRACT
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 Subject(s)
Echocardiography, Doppler/instrumentation
, Heart Ventricles/pathology
, Mitral Valve Insufficiency/pathology
, Myocardium/pathology
, Ventricular Dysfunction, Left/pathology
, Aged
, Analysis of Variance
, Biomarkers
, Case-Control Studies
, Chronic Disease
, Diastole
, Female
, Heart Ventricles/diagnostic imaging
, Humans
, Male
, Mitral Valve Insufficiency/diagnostic imaging
, Statistics as Topic
, Statistics, Nonparametric
, Systole
, Time Factors
, Ventricular Dysfunction, Left/diagnostic imaging
ABSTRACT
AIMS: To study global and regional left atrial (LA) mechanics in chronic primary mitral regurgitation (MR) with echocardiography. METHODS AND RESULTS: LA volumes during reservoir, conduit, and contractile phases were measured in 27 MR patients and 25 controls. LA ejection fraction (EF) and ejection force were calculated. Reservoir (SR-R), conduit (SR-C), and contractile phase (SR-A) strain rates, and reservoir phase strain were obtained. LA volumes were higher in MR in all phases. In MR, ejection force was increased (21.5 vs. 12.3 kdynes, P = 0.001); reservoir phase strain (32.91 +/- 14.26%), SR-R (2.65 +/- 0.87), SR-C (-2.02 +/- 0.58), and SR-A (-2.55 +/- 1.31 s(-1)) were increased (23.14 +/- 7.96%, 1.62 +/- 0.53, -1.29 +/- 0.59, -1.98 +/- 0.65 s(-1), in controls, respectively, P < or = 0.004). Regional deformation correlated with corresponding volumetric parameters. Despite enhanced SR-A in MR, LA EF was unchanged (31.34 vs. 29.23%, P = ns), and LA contractile tissue velocity (A') was reduced (-5.39 +/- 1.95 vs. -6.91 +/- 1.80 cm/s, P = 0.006). The LA contractile contribution to left ventricular filling was significantly reduced in MR. CONCLUSION: LA deformation is increased in all phases in MR. Unchanged LA EF and reduced A' may reflect the reduced contractile contribution to left ventricular filling.
