Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Possibilities of Doppler Tissue Imaging in the evaluationof myocardial function in patients with ischemic mitral regurgitation

Authors: T.K. Turakhonov, I.V. Koksheneva

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2018-15-3-149-161

UDC: 616.127-073.756:616.126.423-005.4

Link: Clinical Physiology of Blood Circulaiton. 2018; 15 (3): 149-161

Quote as: Turakhonov T.K., Koksheneva I.V. Possibilities of Doppler Tissue Imaging in the evaluation of myocardial function in patients with ischemic mitral regurgitation. Clinical Physiology of Circulation. 2018; 15 (3): 149–61 (in Russ.). DOI: 10.24022/1814-6910-2018-15-3-149-161

Received / Accepted:  15.02.2018/13.03.2018

Download
Full text:  

Abstract

The article provides an overview of the published data on the possibilities and prospects for using the method of Doppler Tissue Imaging (DTI) in patients with coronary heart disease with ischemic mitral regurgitation (MR). The main concepts of the pathophysiology of ischemic MR, mechanisms of development of asymmetric and symmetric types of ischemic MR are considered in the article. The principles and possibilities of quantitative methods for the study of myocardial function based on the pulse-wave mode of DTI are briefly presented, as well as estimates of Strain and Strain Rate of the myocardium. The possibilities of DTI in the study of myocardial function for various types of ischemic MP, in the evaluation of the function of the papillary muscles, in the evaluation of mechanics and functions of the left atrium, and in the prediction of the development of cardiac failure in the postoperative period in patients with MP are considered. Potentially, the study of LV myocardial deformation parameters and mitral valve structures (papillary muscles, left atrium myocardium), in addition to existing methods, can be used to predict the dynamics of ischemic mitral regurgitation after myocardial revascularization, and also help in predicting the outcome of reconstructive intervention on the mitral valve.

References

  1. Бузиашвили Ю.И., Кокшенева И.В., Асымбекова Э.У., Тугеева Э.Ф., Голубев Е.П., Мацкеплишвили С.Т.Ишемическая митральная регургитация: механизмы развития и прогрессирования, актуальные вопросы лечебной тактики. М.: НЦССХ им. А.Н. Бакулева; 2015 [Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Tugeeva E.F., Golubev E.P., Matskeplishvili S.T. Ischemic mitral regigitation: mechanisms of development and progressing, topical issues of treatment. Moscow; 2015 (in Russ.).]
  2. Carpentier A., Loulmet D., Deloche A. Surgical anatomy and management of ischemic mitral valve incompetence. Circulation. 1987; 76: 446.
  3. Grigioni F., Enriquez-Sarano M., Zehr K.J., Bailey K.R., Tajik A.J. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001; 103: 1759–64. DOI: 10.1161/01.cir.103.13.1759
  4. Birnbaum Y., Chamoun A.J., Conti V.R., Uretsky B.F. Mitral regurgitation following acute myocardial infarction. Сoron. Artery. Dis. 2002; 13: 337–44. DOI: 10.1097/00019501-200209000-00006
  5. Trichon B.H., Glower D.D., Shaw L.K., Cabell C.H., Anstrom K.J., Felker G.M. et al. Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation. Circulation. 2003; 108 (Suppl. 1): 103–10. DOI: 10.1161/01.cir.0000087656.10829.df
  6. Wierup P., Nielsen S.L., Egeblad H., Scherstén H., Kimblad P.O., Bech-Hansen O. et al. The prevalence of moderate mitral regurgitation in patients undergoing CABG. Scand. Cardiovasc. J. 2009; 43: 46–9. DOI: 10.1080/14017430802430943
  7. Dudzinski D.M., Hung J. Echocardiographic assessment of ischemic mitral regurgitation. Cardiovascular. Ultrasound. 2014; 12 (46): 4–16. DOI: 10.1186/1476-7120-12-46
  8. Salgo I., Gorman J., Gorman R., Jackson B., Bowen F., Plappert T. et al. Effect of annular shape on leaflet curvature in reducing mitral leaflet stress. Circulation. 2002; 106 (6): 711–7. DOI: 10.1161/01.cir.0000025426.39426.83
  9. He S., Lemmon J.D. Jr, Weston M.W., Jensen M.O., Levine R.A., Yoganathan A.P. Mitral valve compensation for annular dilatation: in vitro study into the mechanisms of functional mitral regurgitation with an adjustable annulus model. J. Heart Valve Dis. 1999; 8: 294–302. DOI: 10.1016/s0735-1097(97)84946-7
  10. Burch G.E., De Pasquale N.P., Phillips J.H. Clinical manifestations of papillary muscle dysfunction. Arch. Intern. Med. 1963; 112: 112–7. DOI: 10.1001/archinte.1963.03860010138015
  11. Burch G.E., De Pasquale N.P., Phillips J.H. The syndrome of papillary muscle dysfunction. Am. Heart J. 1968; 75: 399–415. DOI: 10.1016/0002-8703(68)90097-5
  12. Godley R.W., Wann L.S., Rogers E.W., Feigenbaum H., Weyman A.E. Incomplete mitral leaflet closure in patients with papillary muscle dysfunction. Circulation. 1981; 63: 565–71. DOI: 10.1161/01.cir.63.3.565
  13. Ypenburg C., Lancellotti P., Tops L.F., Bleeker G.B., Holman E.R., Piérard L.A. et al. Acute effects of initiation and withdrawal of cardiac resynchronization therapy on papillary muscle dyssynchrony and mitral regurgitation. J. Am. Coll. Cardiol. 2007; 50 (21): 2071–7. DOI: 10.1016/j.jacc.2007.08.019
  14. Levine R.A., Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005; 112 (5): 745–58. DOI: 10.1161/circulationaha.104.486720
  15. Lancellotti P., Zamorano J.L., Vannan M.A. Imaging challenges in secondary mitral regurgitation unsolved issues and perspectives. Circ. Cardiovasc. Imaging. 2014; 7: 735–46. DOI: 10.1161/circimaging.114.000992
  16. Malik V., Subramaniam A., Kapoor P.M. Strain and strain rate: an emerging technology in the perioperative period. Ann. Card. Anaesth. 2016; 19: 112–21. DOI: 10.4103/0971-9784.173026
  17. Науменко Е.П., Шилова В.А., Семеняго Е.Ф., Коржева С.Н. Возможности современной тканевой допплерографии в диагностике нарушений структурно-функционального состояния миокарда у пациентов с ишемической болезнью сердца и сахарным диабетом 2 типа (практическое пособие для врачей). Гомель: РНПЦ РМиЭЧ; 2014. [Naumenko E.P., Shilova V.A., Semenyago E.F., Korzheva S.N. Possibilities of modern tissue dopplerography in the diagnosis of structural myocardial dysfunction in patients with coronary heart disease and type 2 diabetes mellitus (practical guide for physicians). Homel; 2014 (in Russ.).]
  18. Claus P., Omar A.M.S., Pedrizzetti G., Sengupta P.P., Nagel E. Tissue tracking technology for assessing cardiac mechanics principles, normal values, and clinical applications. JACC Cardiovasc. Imag. 2015; 8 (12): 1444–60. DOI: 10.1016/j.jcmg.2015.11.001
  19. Kadappu K.K., Thomas L. Tissue Doppler Imaging in echocardiography: value and limitations. Heart, Lung Circ. 2015; 24: 224–33. DOI: 10.1016/j.hlc.2014.10.003
  20. Mada R.O., Duchenne J., Voigt J.U. Tissue Doppler, Strain and Strain Rate in ischemic heart disease “How I do it”. Cardiovasc. Ultrasound. 2014; 12 (38): 1–9. DOI: 10.1186/1476-7120-12-38
  21. Lancellotti P., Tribouilloy C., Hagendorff A., Popescu B.A., Edvardsen T., Pierard L.A. et al. Scientific Document Committee of the European Association of Cardiovascular Imaging. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging. 2013; 14: 611–44. DOI: 10.1093/ehjci/jet105
  22. Lancellotti P., Cosyns B., Zacharakis D., Attena E., Camp G.V., Gach O. et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J. Am. Soc. Echocardiogr. 2008; 21: 1331–6. DOI: 10.1016/j.echo.2008.09.023
  23. Zito C., Cusma-Piccione M., Oreto L., Tripepi S., Mohammed M., Di Bella G. et al. In patients with postinfarction left ventricular dysfunction, how does impaired basal rotation affect chronic ischemic mitral regurgitation? J. Am. Soc. Echocardiogr. 2013; 26: 1118–29. DOI: 10.1016/j.echo.2013.04.017
  24. Tatsumi K., Kawai H., Sugiyama D., Norisada K., Kataoka T., Onishi T. et al. Dobutamine-induced improvement in inferior myocardial contractile function predicts reduction in functional mitral regurgitation a study using tissue Doppler Strain Rate imaging. Circ. Cardiovasc. Imaging. 2010; 3: 638–46. DOI: 10.1161/circimaging.110.937300
  25. Messas E., Gorier J.L., Handschumacher M.D., Chow C.M., Sullivan S., Schwammenthal E. et al. Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insights from three – dimensional and contrast echocardiography with strain rate measurement. Circulation. 2001; 104: 1952–7. DOI: 10.1161/hc4101.097112
  26. Uemura T., Otsuji Y., Nakashiki K., Yoshifuku S., Maki Y., Yu B. et al. Papillary muscle dysfunction attenu- ates ischemic mitral regurgitation in patients with localized basal inferior left ventricular remodeling insights from tissue Doppler Strain imaging. J. Am. Coll. Cardiol. 2005; 46: 113–9. DOI: 10.1016/j.jacc.2005.03.049
  27. Хуцураули Е.М. Прогрессирование недостаточнос- ти митрального клапана у больных ИБС после операций аортокоронарного шунтирования и хи- рургической реконструкции левого желудочка: фак- торы риска, механизмы развития, стратегии профи- лактики: Дис. … канд. мед. наук. М.; 2012. [Khutsurauli E.M. Progression of mitral valve insufficiency in patients with coronary heart disease after aortocoronary bypass surgery and surgical reconstruction of the left ventricle: risk factors, development mechanisms, prevention strategies. Сand. Med. Sc. Diss. Moscow; 2012 (in Russ.).]
  28. Бузиашвили Ю.И., Кокшенева И.В., Абуков С.Т., Абдуллаев А.А. Значение функции папиллярных мышц митрального клапана и прилежащих сегментов миокарда левого желудочка в прогрессировании ишемической митральной регургитации у больных ишемической болезнью сердца после хирургического лечения. Терапевтический архив. 2015; 87 (8): 9–15. DOI: 10.17116/terarkh20158789-15 [Buziashvili Yu.I., Koksheneva I.V., Abukov S.T., Abdullaev A.A. Significance of papillary muscle function of the mitral valve and adjacent left ventricular segments in the progression of ischemic mitral regurgitation in patients with coronary heart disease after surgical treatment. Terapevticheskiy Arkhiv (Therapeutic Archive). 2015; 87 (8): 9–15 (in Russ.). DOI: 10.17116/terarkh20158789-15]
  29. Enriquez-Sarano M., Akins C.W., Vahanian A. Mitral regurgitation. Lancet. 2009; 373: 1382–94. DOI: 10.1016/s0140-6736(09)60692-9
  30. Saraiva R.M., Demirkol S., Buakhamsri A., Greenberg N., Popović Z.B., Thomas J.D. et al. Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J. Am. Soc. Echocardiogr. 2010; 23 (2): 172–80. DOI: 10.1016/j.echo.2009.11.003
  31. Cameli M., Caputo M., Mondillo S., Ballo P., Palmerini E., Lisi M. et al. Feasibility and reference values of left atrial longitudinal strain imaging by two dimensional speckle tracking. Cardiovasc. Ultrasound. 2009; 7: 6. DOI: 10.1186/1476-7120-7-6
  32. Rimba5 s R.C., Dulgheru R.E., Vinereanu D. Methodological gaps in left atrial function assessment by 2D speckle tracking echocardiography. Arq. Bras. Cardiol. 2015; 105 (6): 625–36. DOI: 10.5935/abc.20150144
  33. Aksakal E., 5Sim5sek Z., Sevimli S., Karakelleoglu S., Erol M.K., Tanboga I.H. et al. Quantitative assessment of the left atrial myocardial deformation in patients with chronic mitral regurgitation by strain and strain rate imaging: an observational study. Anadolu. Kardiyol. Derg. 2012; 12: 377–83. DOI: 10.5152/akd.2012.120
  34. Van Garsse L., Gelsomino S., Luca F., Parise O., Cheriex E., Rao C.M. et al. Left atrial strain and strain rate before and following restrictive annuloplasty for ischaemic mitral regurgitation evaluated by two-dimensional speckle tracking echocardiography. Eur. Heart J. Cardiovasc. Imaging. 2013; 14: 534–43. DOI: 10.1093/ehjci/jes206
  35. Debonnaire P., Leong D.P., Witkowski T.G., Amri I.A., Joyce E., Katsanos S. et al. Left atrial function by twodimensional speckle-tracking echocardiography in patients with severe organic mitral regurgitation: association with guidelines-based surgical indication and postoperative (long-term) survival. J. Am. Soc. Echocardiogr. 2013; 26 (9): 1053–62. DOI: 10.1016/j.echo.2013.05.019
  36. Джобава Е.Р. Функциональный и анатомический статус митрального и трикуспидального клапанов при различных формах фибрилляции предсердий: Дис. … канд. мед. наук. М.; 2016. [Dzhobava E.R. Functional and anatomical status of mitral and tricuspid valves in various forms of atrial fibrillation: Cand. Med. Sc. Diss. Moscow; 2016 (in Russ.).]
  37. Florescu M., Benea D.C.C.M., Rimbas R.C., Cerin G., Diena M., Lanzzillo G. et al. Myocardial systolic velocities and deformation assessed by speckle tracking for early detection of left ventricular dysfunction in asymptomatic patients with severe primary mitral regurgitation. Echocardiography. 2012; 29: 326–33. DOI: 10.1111/j.1540-8175.2011.01563.x
  38. Kim M.S., Kim Y.J., Kim H.K., Han J.Y., Chun H.G., Kim H.C. et al. Evaluation of left ventricular short- and long-axis function in severe mitral regurgitation using 2-dimensional strain echocardiography. Am. Heart J. 2009; 157: 345–51. DOI: 10.1016/j.ahj.2008.10.004
  39. Mascle S., Schnell F., Thebault C., Corbineau H., Laurent M., Hamonic S. et al. Predictive value of global longitudinal strain in a surgical population of organic mitral regurgitation. J. Am. Soc. Echocardiogr. 2012; 25 (7): 766–72. DOI: 10.1016/j.echo.2012.04.009
  40. Marciniak A., Claus P., Sutherland G.R., Marciniak M. Changes in systolic left ventricular function in isolated mitral regurgitation. A strain rate imaging study. Eur. Heart J. 2007; 28: 2627–36. DOI: 10.1093/eurheartj/ehm072
  41. Witkowski T.G., Thomas J.D., Philippe J.M.R., Delgado V., Hoke U., Ewe S.H. et al. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur. Heart J. Cardiovasc. Imag. 2013; 14: 69–76. DOI: 10.1093/ehjci/jes155
  42. Kamperidis V., Marsan N.A., Delgado V., Bax J.J. Left ventricular systolic function assessment in secondary mitral regurgitation: left ventricular ejection fraction vs. speckle tracking global longitudinal strain. Eur. Heart J. 2016; 37 (10): 811–6. DOI: 10.1093/eurheartj/ehv680
  43. Casas-Rojo E., Fernández-Golfin C., Moya-Mur J.L., González-Gómez A., García-Martín A., Morán- Fernández L. et al. Area strain from 3D speckle-tracking echocardiography as an independent predictor of early symptoms or ventricular dysfunction in asymptomatic severe mitral regurgitation with preserved ejection fraction. Int. J. Cardiovasc. Imaging. 2016; 32 (8): 1189–98. DOI: 10.1007/s10554-016-0904-2
  44. Candan O., Hatipoglu Akpinar S., Dogan C., DemirkIran A., Dindar B., Bayram Z. еt al. Twist deformation for predicting postoperative left ventricular function in patients with mitral regurgitation: a speckle tracking echocardiography study. Echocardiography. 2017; 34 (3): 422–8. DOI: 10.1111/echo.13462
  45. Cho E.J., Park S.J., Yun H.R., Jeong D.S., Lee S.C., Park S.W. et al. Predicting left ventricular dysfunction after surgery in patients with chronic mitral regurgitation: assessment of myocardial deformation by 2-Dimensional multilayer speckle tracking echocardiography. Korean Circ. J. 2016; 46 (2): 213–21. DOI: 10.4070/kcj.2016.46.2.213

About Authors

  • Turakhonov Timur Kurbanalievich, Postgraduate
  • Koksheneva Inna Valerievna, Dr. Med. Sc., Senior Researcher; orcid.org/0000-0002-8797-9340

 If you found mistakes, select text and press Alt+A