Background Patients with chronic coronary artery disease have double the mortality rate if the condition is combined with functional mitral regurgitation. An understanding based on geometric alterations of the mitral ...Background Patients with chronic coronary artery disease have double the mortality rate if the condition is combined with functional mitral regurgitation. An understanding based on geometric alterations of the mitral apparatus in functional mitral regurgitation is desirable. Methods Twenty-nine subjects were enrolled in the study, including 9 healthy volunteers(control group), 12 patients with chronic coronary artery disease without functional mitral regurgitation(CAD group), and 8 patients with chronic coronary artery disease with functional mitral regurgitation(CAD+FMR group). Cine magnetic resonance imaging was performed to acquire multiple short-axis cine images from base to apex. Left ventricular end-systolic volume, left ventricular ejection fraction, mitral area, and vertices of the mitral tetrahedron, defined by medial and lateral papillary muscle roots and anterior and posterior mitral annulus, were determined from reconstructed images at end-systole. Anterior-posterior annular distance, interpapillary distance, and annular-papillary distance(the distance from the anterior or posterior mitral annulus to the medial or lateral papillary muscle roots) were calculated. Results Left ventricular end-systolic volume was inversely associated with left ventricular ejection fraction(R2=0.778). Left ventricular end-systolic volume was highly associated with distances related to ventricular geometry(R2=0.742 for interpapillary distance, 0.792 for the distance from the anterior mitral annulus to the medial papillary muscle root, and 0.769 for distance from the anterior mitral annulus to the lateral papillary muscle root) but was moderately associated with distances related to annular geometry(R2=0.458 for anterior-posterior annular distance and 0.594 for mitral area, respectively). Moreover, interpapillary distance of greater than 32 mm and distance from the anterior mitral annulus to the medial papillary muscle root of greater than 64 mm readily distinguished the CAD+FMR group from the other groups. Conclusion In pa展开更多
Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribu...Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribution to ventricular fil ling was studied before and after balloon mitral valvuloplasty (BMV) and on foll ow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm ( n=59) were divided into group I (< 18 years, n=13), group II (< 30 years, n=29) and group III (>30 years, n=17). Two-dimensional mitral valve area (MVA in cm2) , transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference betwe en total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-%before and after BMV (δ-A-%) were n oted. Follow-up data was obtained at 1 year. The change in A-%at follow-up ( A-%-FU) was calculated as the difference between A-%before BMV and A-%at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-%were simi lar. After BMV, there was increase in A-VTI and A-%in all the groups with a t rend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, δ-A-%after BMV was significantly higher (13.2±7.6, 7.9±5.1 and 6.5±4.5, respectively, in groups I, II and III; p< 0.01). Correlation coefficient of age against δ-A-%was -0.55 (p< 0.01). Correlation coefficients of δ-A-%against post-BMV-MVA and MG were not goo d. At follow-up of 11.3±1.2 months, changes achieved in total VTI, A-VTI, EVT I and A-%were maintained. Total VTI, A-VTI, E-VTI and A-%were similar at t he time of follow-up on comparing the three groups. But younger patients had si gnificantl展开更多
In the last decade, multiple studies depicted discrepancies between mitral valvular orifice area(MVA) measurements obtained with the pressure half-time(PHT) method and invasive methods during the immediate post-percut...In the last decade, multiple studies depicted discrepancies between mitral valvular orifice area(MVA) measurements obtained with the pressure half-time(PHT) method and invasive methods during the immediate post-percutaneous mitral valvuloplasty(PMV) period. Our aim was to assess the accuracy of Real-Time 3D echo(RT3D) to measure the MVA in the immediate post-PMV period. The invasively determined MVA was used as the gold standard. We studied 29 patients with rheumatic mitral stenosis from two centres(27 women; mean age 48.2±11.3 years), all of which had underwent PMV. MVA was calculated before and after PMV using the PHT method, 2D echo planime try, RT3D echo planimetry and invasive determination (Gorlin’s method). The RT3D MVA assessment showed a better agreement with the invasively derived MVA before and in the immediate post-PMV period (Bland-Altman analysis: Average difference between both methods and limits of agreement: 0.01(-0.31 to 0.33) cm2 and -0.12(-0.71 to 0.47) cm2) before and immediately after the PMV, respectively. RT3D is a feasible and accurate technique for measuring MVA in patients with RMVS. It has the best agreement with the invasively determined MVA, particularly in the immediate post-PMV period.展开更多
Objectives The purpose of this study was to evaluate the reliability of the pr essure half-time(PHT) method for estimating mitral valve areas(MVAs) by velocit y-encoded cardiovascular magnetic resonance(VE-CMR) and to...Objectives The purpose of this study was to evaluate the reliability of the pr essure half-time(PHT) method for estimating mitral valve areas(MVAs) by velocit y-encoded cardiovascular magnetic resonance(VE-CMR) and to compare the method with paired Doppler ultrasound. Background The pressure halftime Doppler echocar diography method is a practical technique for clinical evaluation of mitral sten osis. As CMR continues evolving as a routine clinical tool, its use for estimati ng MVA requires thorough evaluation. Methods Seventeen patients with mitral sten osis underwent echocardiography and CMR. Using VE-CMR, MVA was estimated by PHT method. Additionally, peak E and peak A velocities were defined. Interobserver repeatability of VE-CMR was evaluated. Results By Doppler, MVAs ranged from 0.8 7 to 4.49 cm2; by CMR, 0.91 to 2.70 cm2, correlating well between modalities (r= 0.86). The correlation coefficient for peak E and peak A between modalities was 0.81 and 0.89, respectively. Velocity-encoded CMR data analysis provided robust , repeatable estimates of peak E, peak A, and MVA (r=0.99, 0.99, and 0.96, respe ctively). Conclusions Velocity-encoded cardiovascular magnetic resonance can be used routinely as a robust tool to quantify MVA via mitral flow velocity analys is with PHT method.展开更多
文摘Background Patients with chronic coronary artery disease have double the mortality rate if the condition is combined with functional mitral regurgitation. An understanding based on geometric alterations of the mitral apparatus in functional mitral regurgitation is desirable. Methods Twenty-nine subjects were enrolled in the study, including 9 healthy volunteers(control group), 12 patients with chronic coronary artery disease without functional mitral regurgitation(CAD group), and 8 patients with chronic coronary artery disease with functional mitral regurgitation(CAD+FMR group). Cine magnetic resonance imaging was performed to acquire multiple short-axis cine images from base to apex. Left ventricular end-systolic volume, left ventricular ejection fraction, mitral area, and vertices of the mitral tetrahedron, defined by medial and lateral papillary muscle roots and anterior and posterior mitral annulus, were determined from reconstructed images at end-systole. Anterior-posterior annular distance, interpapillary distance, and annular-papillary distance(the distance from the anterior or posterior mitral annulus to the medial or lateral papillary muscle roots) were calculated. Results Left ventricular end-systolic volume was inversely associated with left ventricular ejection fraction(R2=0.778). Left ventricular end-systolic volume was highly associated with distances related to ventricular geometry(R2=0.742 for interpapillary distance, 0.792 for the distance from the anterior mitral annulus to the medial papillary muscle root, and 0.769 for distance from the anterior mitral annulus to the lateral papillary muscle root) but was moderately associated with distances related to annular geometry(R2=0.458 for anterior-posterior annular distance and 0.594 for mitral area, respectively). Moreover, interpapillary distance of greater than 32 mm and distance from the anterior mitral annulus to the medial papillary muscle root of greater than 64 mm readily distinguished the CAD+FMR group from the other groups. Conclusion In pa
文摘Objective: Ventricular filling takes place during the conduit and pump functio ns of the atrium. While studying whether relief of mitral valve obstruction impr oves atrial filling, the effect of age on atrial contribution to ventricular fil ling was studied before and after balloon mitral valvuloplasty (BMV) and on foll ow-up at 1 year. Methods: Patients with mitral stenosis (MS) and sinus rhythm ( n=59) were divided into group I (< 18 years, n=13), group II (< 30 years, n=29) and group III (>30 years, n=17). Two-dimensional mitral valve area (MVA in cm2) , transmitral mean gradient (MG in mm Hg), velocity time integral (VTI in cm) of mitral valve flow, VTI contributed by atrial systole (A-VTI), difference betwe en total VTI and A-VTI (E-VTI), percentage contribution of A-VTI to the total VTI (A-%) and difference between A-%before and after BMV (δ-A-%) were n oted. Follow-up data was obtained at 1 year. The change in A-%at follow-up ( A-%-FU) was calculated as the difference between A-%before BMV and A-%at follow-up. Results: There was a similar increase in MVA with a reduction in MG among the three groups. Among the three groups, total VTI and E-VTI before and after BMV were similar. Before BMV, in all the groups, A-VTI and A-%were simi lar. After BMV, there was increase in A-VTI and A-%in all the groups with a t rend to be more in younger patients. A-VTI was significantly higher in group I only. But E-VTI had decreased significantly in all groups and tended to be less in younger patients. In younger patients, δ-A-%after BMV was significantly higher (13.2±7.6, 7.9±5.1 and 6.5±4.5, respectively, in groups I, II and III; p< 0.01). Correlation coefficient of age against δ-A-%was -0.55 (p< 0.01). Correlation coefficients of δ-A-%against post-BMV-MVA and MG were not goo d. At follow-up of 11.3±1.2 months, changes achieved in total VTI, A-VTI, EVT I and A-%were maintained. Total VTI, A-VTI, E-VTI and A-%were similar at t he time of follow-up on comparing the three groups. But younger patients had si gnificantl
文摘In the last decade, multiple studies depicted discrepancies between mitral valvular orifice area(MVA) measurements obtained with the pressure half-time(PHT) method and invasive methods during the immediate post-percutaneous mitral valvuloplasty(PMV) period. Our aim was to assess the accuracy of Real-Time 3D echo(RT3D) to measure the MVA in the immediate post-PMV period. The invasively determined MVA was used as the gold standard. We studied 29 patients with rheumatic mitral stenosis from two centres(27 women; mean age 48.2±11.3 years), all of which had underwent PMV. MVA was calculated before and after PMV using the PHT method, 2D echo planime try, RT3D echo planimetry and invasive determination (Gorlin’s method). The RT3D MVA assessment showed a better agreement with the invasively derived MVA before and in the immediate post-PMV period (Bland-Altman analysis: Average difference between both methods and limits of agreement: 0.01(-0.31 to 0.33) cm2 and -0.12(-0.71 to 0.47) cm2) before and immediately after the PMV, respectively. RT3D is a feasible and accurate technique for measuring MVA in patients with RMVS. It has the best agreement with the invasively determined MVA, particularly in the immediate post-PMV period.
文摘Objectives The purpose of this study was to evaluate the reliability of the pr essure half-time(PHT) method for estimating mitral valve areas(MVAs) by velocit y-encoded cardiovascular magnetic resonance(VE-CMR) and to compare the method with paired Doppler ultrasound. Background The pressure halftime Doppler echocar diography method is a practical technique for clinical evaluation of mitral sten osis. As CMR continues evolving as a routine clinical tool, its use for estimati ng MVA requires thorough evaluation. Methods Seventeen patients with mitral sten osis underwent echocardiography and CMR. Using VE-CMR, MVA was estimated by PHT method. Additionally, peak E and peak A velocities were defined. Interobserver repeatability of VE-CMR was evaluated. Results By Doppler, MVAs ranged from 0.8 7 to 4.49 cm2; by CMR, 0.91 to 2.70 cm2, correlating well between modalities (r= 0.86). The correlation coefficient for peak E and peak A between modalities was 0.81 and 0.89, respectively. Velocity-encoded CMR data analysis provided robust , repeatable estimates of peak E, peak A, and MVA (r=0.99, 0.99, and 0.96, respe ctively). Conclusions Velocity-encoded cardiovascular magnetic resonance can be used routinely as a robust tool to quantify MVA via mitral flow velocity analys is with PHT method.
