Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study

Reham Mostafa Elgammal; Mona Adel Elsaiedy; Mahmoud Zki Alamrosy; Mohamed Elsaied Elsetiha; Magdy Mohamed Almasry

doi:doi:10.11648/j.ccr.20230702.14

| Peer-Reviewed

Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study

Reham Mostafa Elgammal, Mona Adel Elsaiedy, Mahmoud Zki Alamrosy, Mohamed Elsaied Elsetiha, Magdy Mohamed Almasry

Published in Cardiology and Cardiovascular Research (Volume 7, Issue 2)

Received: 18 February 2023 Accepted: 4 March 2023 Published: 31 May 2023

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases. Aim of the study: Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR). Methods: 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis. Results: End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P <0.001). EDV measures were strongly correlated with CMR and 3D echocardiography (r=0.88, p < 0.001).2D echo ESV measures were strongly correlated with CMR and 3D echo (r=0.7 and 0.63 respectively, P<0.001).3D echo ESV measures were moderately correlated with CMR (r=0.5, P<0.001). GLS values measured by 2D and CMR were moderately correlated (r=0.5, p<0.001). Conclusion: Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.

Published in	Cardiology and Cardiovascular Research (Volume 7, Issue 2)
DOI	10.11648/j.ccr.20230702.14
Page(s)	38-49
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Primary Mitral Regurgitation, MR, CMR, 2D Echo, 3D Echo, GLS, Left Ventricle

References

[1]	Harb SC, Griffin BP. Mitral Valve Disease: a Comprehensive Review. Curr Cardiol Rep. 2017 Aug; 19 (8): 73.
[2]	Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et. al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017 Apr; 30 (4): 303-371.
[3]	Podlesnikar T, Delgado V, Bax JJ. Cardiovascular magnetic resonance imaging to assess myocardial fibrosis in valvular heart disease. Int J Cardiovasc Imaging. 2018 Jan; 34 (1): 97-112.
[4]	Quintana E, Suri RM, Thalji NM, Daly RC, Dearani JA, Burkhart HM, Li Z, Enriquez-Sarano M, Schaff HV. Left ventricular dysfunction after mitral valve repair—the fallacy of “normal” preoperative myocardial function. Thorac Cardiovasc Surg, 148 (2014), pp. 2752-2760.
[5]	Enriquez-Sarano M, Suri RM, Clavel MA, Mantovani F, Michelena HI, Pislaru S, Mahoney DW, Schaff HV. Is there an outcome penalty linked to guideline-based indications for valvular surgery? Early and long-term analysis of patients with organic mitral regurgitation. J Thorac Cardiovasc Surg (2015); 150: 50–8.
[6]	Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg. (2018) Apr; 8 (3): 342-359.6.
[7]	Luis SA, Chan J, Pellikka PA. Echocardiographic Assessment of Left Ventricular Systolic Function: An Overview of Contemporary Techniques, Including Speckle-Tracking Echocardiography. Mayo Clin Proc. (2019) Jan; 94 (1): 125-138.
[8]	Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. (2005); 18: 1440-1463.
[9]	Seo Y, Ishizu T, Atsumi A, Kawamura R, Aonuma K l. Three-dimensional speckle tracking echocardiography. Circ J. (2014); 78 (6): 1290-301.
[10]	Zorzi A, Susana A, De Lazzari M, Migliore F, Vescovo G, Scarpa D, et. al. Diagnostic value and prognostic implications of early cardiac magnetic resonance in survivors of out-of-hospital cardiac arrest. Heart Rhythm. 2018 Jul; 15 (7).
[11]	Doltra A, Amundsen BH, Gebker R, Fleck E, Kelle S. Emerging concepts for myocardial late gadolinium enhancement MRI. Curr Cardiol Rev. (2013) Aug; 9 (3): 185-90.
[12]	Schuster A, Morton G, Hussain ST, Jogiya R, Kutty S, Asrress KN, et al. The intra-observer reproducibility of cardiovascular magnetic resonance myocardial feature tracking strain assessment is independent of field strength. Eur J Radiol. (2013); 82: 296–301.
[13]	Levine RA, Hagége AA, Judge DP, Padala M, Dal-Bianco JP, Aikawa E, et al. Mitral valve disease--morphology and mechanisms. Nat Rev Cardiol. (2015); 12 (12): 689-710.
[14]	Salihi S, Güden M. Durability of mitral valve repair: A single center experience. Turk Gogus Kalp Damar Cerrahisi Derg. 2019 Oct 23; 27 (4): 459-468.
[15]	Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J,. et. al. ESC/EACTS Scientific Document Group, 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). European Heart Journal, (2021). ehab395.
[16]	Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, et al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr, 25 (2012), pp. 3-46.
[17]	Levy F, Marechaux S, Iacuzio L, Schouver ED, Castel AL, Toledano M, et. al. Quantitative assessment of primary mitral regurgitation using left ventricular volumes obtained with new automated three-dimensional transthoracic echocardiographic software: A comparison with 3-Tesla cardiac magnetic resonance. Arch Cardiovasc Dis. (2018) Aug-Sep; 111 (8-9): 507-517.
[18]	Van De Heyning CM, Magne J, Piérard LA, Bruyère PJ, Davin L, De Maeyer C, Paelinck BP, et. al. Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance. Cardiovasc Ultrasound. (2013) Dec 27; 11: 46.
[19]	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): 766-772.
[20]	Alashi A, Mentias A, Patel K, Gillinov AM, Sabik JF, Popović Z, et al. Synergistic utility of brain natriuretic peptide and left ventricular global longitudinal strain in asymptomatic patients with significant primary mitral regurgitation and preserved systolic function undergoing mitral valve surgery. Circ Cardiovasc Imaging. (2016); 9 (7): e004451.
[21]	Nesser HJ, Mor-Avi V, Gorissen W, Weinert L, Steringer-Mascherbauer R, Niel J, et. al. Quantification of left ventricular volumes using three-dimensional echocardiographic speckle tracking: comparison with MRI. European Heart Journal, Volume 30, Issue 13, July (2009), Pages 1565–1573.
[22]	Kitkungvan D, Nabi F, Kim RJ, Bonow RO, Khan MA, Xu J, Little SH, et. al. Myocardial Fibrosis in Patients With Primary Mitral Regurgitation With and Without Prolapse. J Am Coll Cardiol. (2018) Aug 21; 72 (8): 823-834.
[23]	Edwards NC, Moody WE, Yuan M, Weale P, Neal D, Townend JN, et al. Quantification of left ventricular interstitial fibrosis in asymptomatic chronic primary degenerative mitral regurgitation. Circ Cardiovasc Imaging, 7 (2014), pp. 946-953.
[24]	Van De Heyning CM, Magne J, Piérard LA, Bruyère PJ, Davin L, De Maeyer C, et al. Late gadolinium enhancement CMR in primary mitral regurgitation. Eur J Clin Invest, 44 (2014), pp. 840-847.

Cite This Article

Plain Text BibTeX RIS

APA Style

Reham Mostafa Elgammal, Mona Adel Elsaiedy, Mahmoud Zki Alamrosy, Mohamed Elsaied Elsetiha, Magdy Mohamed Almasry. (2023). Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiology and Cardiovascular Research, 7(2), 38-49. https://doi.org/10.11648/j.ccr.20230702.14

Copy | Download

ACS Style

Reham Mostafa Elgammal; Mona Adel Elsaiedy; Mahmoud Zki Alamrosy; Mohamed Elsaied Elsetiha; Magdy Mohamed Almasry. Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiol. Cardiovasc. Res. 2023, 7(2), 38-49. doi: 10.11648/j.ccr.20230702.14

Copy | Download

AMA Style

Reham Mostafa Elgammal, Mona Adel Elsaiedy, Mahmoud Zki Alamrosy, Mohamed Elsaied Elsetiha, Magdy Mohamed Almasry. Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiol Cardiovasc Res. 2023;7(2):38-49. doi: 10.11648/j.ccr.20230702.14

Copy | Download

@article{10.11648/j.ccr.20230702.14,
  author = {Reham Mostafa Elgammal and Mona Adel Elsaiedy and Mahmoud Zki Alamrosy and Mohamed Elsaied Elsetiha and Magdy Mohamed Almasry},
  title = {Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {2},
  pages = {38-49},
  doi = {10.11648/j.ccr.20230702.14},
  url = {https://doi.org/10.11648/j.ccr.20230702.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230702.14},
  abstract = {Background: Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases. Aim of the study: Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR). Methods: 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis. Results: End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P  Conclusion: Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study
AU  - Reham Mostafa Elgammal
AU  - Mona Adel Elsaiedy
AU  - Mahmoud Zki Alamrosy
AU  - Mohamed Elsaied Elsetiha
AU  - Magdy Mohamed Almasry
Y1  - 2023/05/31
PY  - 2023
N1  - https://doi.org/10.11648/j.ccr.20230702.14
DO  - 10.11648/j.ccr.20230702.14
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 38
EP  - 49
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20230702.14
AB  - Background: Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases. Aim of the study: Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR). Methods: 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis. Results: End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P  Conclusion: Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.
VL  - 7
IS  - 2
ER  -

Copy | Download

Author Information

Reham Mostafa Elgammal

Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Mona Adel Elsaiedy

Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Mahmoud Zki Alamrosy

Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Mohamed Elsaied Elsetiha

Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
Magdy Mohamed Almasry

Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Reham Mostafa Elgammal, Mona Adel Elsaiedy, Mahmoud Zki Alamrosy, Mohamed Elsaied Elsetiha, Magdy Mohamed Almasry. (2023). Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiology and Cardiovascular Research, 7(2), 38-49. https://doi.org/10.11648/j.ccr.20230702.14

Copy | Download

ACS Style

Reham Mostafa Elgammal; Mona Adel Elsaiedy; Mahmoud Zki Alamrosy; Mohamed Elsaied Elsetiha; Magdy Mohamed Almasry. Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiol. Cardiovasc. Res. 2023, 7(2), 38-49. doi: 10.11648/j.ccr.20230702.14

Copy | Download

AMA Style

Reham Mostafa Elgammal, Mona Adel Elsaiedy, Mahmoud Zki Alamrosy, Mohamed Elsaied Elsetiha, Magdy Mohamed Almasry. Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study. Cardiol Cardiovasc Res. 2023;7(2):38-49. doi: 10.11648/j.ccr.20230702.14

Copy | Download

@article{10.11648/j.ccr.20230702.14,
  author = {Reham Mostafa Elgammal and Mona Adel Elsaiedy and Mahmoud Zki Alamrosy and Mohamed Elsaied Elsetiha and Magdy Mohamed Almasry},
  title = {Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study},
  journal = {Cardiology and Cardiovascular Research},
  volume = {7},
  number = {2},
  pages = {38-49},
  doi = {10.11648/j.ccr.20230702.14},
  url = {https://doi.org/10.11648/j.ccr.20230702.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20230702.14},
  abstract = {Background: Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases. Aim of the study: Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR). Methods: 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis. Results: End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P  Conclusion: Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study
AU  - Reham Mostafa Elgammal
AU  - Mona Adel Elsaiedy
AU  - Mahmoud Zki Alamrosy
AU  - Mohamed Elsaied Elsetiha
AU  - Magdy Mohamed Almasry
Y1  - 2023/05/31
PY  - 2023
N1  - https://doi.org/10.11648/j.ccr.20230702.14
DO  - 10.11648/j.ccr.20230702.14
T2  - Cardiology and Cardiovascular Research
JF  - Cardiology and Cardiovascular Research
JO  - Cardiology and Cardiovascular Research
SP  - 38
EP  - 49
PB  - Science Publishing Group
SN  - 2578-8914
UR  - https://doi.org/10.11648/j.ccr.20230702.14
AB  - Background: Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases. Aim of the study: Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR). Methods: 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis. Results: End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P  Conclusion: Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.
VL  - 7
IS  - 2
ER  -

Copy | Download