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Effect of Primary Mitral Regurgitation on Left Ventricular Synchrony
Mitral regurgitation (MR) promotes left ventricular (LV) dilatation and eccentric remodeling. In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderat...
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| Published in: | The American journal of cardiology 2007-08, Vol.100 (4), p.707-711 |
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| container_title | The American journal of cardiology |
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| creator | Denney, Thomas S., PhD Nagaraj, Hosakote M., MD Lloyd, Steven G., MD, PhD Aban, Inmaculada, PhD Corros, Cecilia, MD Seghatol-Eslami, Frank, MD McGiffin, David C., MD Dell’Italia, Louis J., MD Gupta, Himanshu, MD |
| description | Mitral regurgitation (MR) promotes left ventricular (LV) dilatation and eccentric remodeling. In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderate to severe primary MR causes LV dyssynchrony in the presence of LV dilation and an ejection fraction (EF) >55%. We studied 37 normal subjects and 22 patients with moderate to severe MR and no coronary artery disease. Electrocardiographically gated cine and tagged cardiac magnetic resonance imaging was performed. Two-dimensional, maximum-circumferential shortening strain and time-to-peak strain (TTPS) were computed using harmonic-phase analysis of tagged magnetic resonance imaging. LV dyssynchrony was assessed by comparing TTPS delay of various LV quadrants and TTPS dispersion among the contralateral quadrants in patients with MR and normal subjects. Statistical comparison was done using a generalized linear model for repeated measurements. LV end-diastolic and LV end-systolic volumes were significantly larger in patients with MR versus normal subjects (207 ± 11 vs 130 ± 4 and 73 ± 5 vs 47 ± 2 ml, p |
| doi_str_mv | 10.1016/j.amjcard.2007.03.088 |
| format | article |
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In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderate to severe primary MR causes LV dyssynchrony in the presence of LV dilation and an ejection fraction (EF) >55%. We studied 37 normal subjects and 22 patients with moderate to severe MR and no coronary artery disease. Electrocardiographically gated cine and tagged cardiac magnetic resonance imaging was performed. Two-dimensional, maximum-circumferential shortening strain and time-to-peak strain (TTPS) were computed using harmonic-phase analysis of tagged magnetic resonance imaging. LV dyssynchrony was assessed by comparing TTPS delay of various LV quadrants and TTPS dispersion among the contralateral quadrants in patients with MR and normal subjects. Statistical comparison was done using a generalized linear model for repeated measurements. LV end-diastolic and LV end-systolic volumes were significantly larger in patients with MR versus normal subjects (207 ± 11 vs 130 ± 4 and 73 ± 5 vs 47 ± 2 ml, p <0.001). LVEF did not differ in patients with MR and normal subjects. The difference in the TTPS among various quadrants and the dispersion among the contralateral quadrants of the LV myocardium was similar between patients with MR and normal subjects. In conclusion, moderate to severe MR does not cause LV dyssynchrony in patients with LV dilatation and normal LVEF. Thus, cardiac resynchronization therapy in the absence of LV dyssynchrony may not decrease the severity of MR.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2007.03.088</identifier><identifier>PMID: 17697833</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; Cardiac Volume - physiology ; Cardiology. 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In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderate to severe primary MR causes LV dyssynchrony in the presence of LV dilation and an ejection fraction (EF) >55%. We studied 37 normal subjects and 22 patients with moderate to severe MR and no coronary artery disease. Electrocardiographically gated cine and tagged cardiac magnetic resonance imaging was performed. Two-dimensional, maximum-circumferential shortening strain and time-to-peak strain (TTPS) were computed using harmonic-phase analysis of tagged magnetic resonance imaging. LV dyssynchrony was assessed by comparing TTPS delay of various LV quadrants and TTPS dispersion among the contralateral quadrants in patients with MR and normal subjects. Statistical comparison was done using a generalized linear model for repeated measurements. LV end-diastolic and LV end-systolic volumes were significantly larger in patients with MR versus normal subjects (207 ± 11 vs 130 ± 4 and 73 ± 5 vs 47 ± 2 ml, p <0.001). LVEF did not differ in patients with MR and normal subjects. The difference in the TTPS among various quadrants and the dispersion among the contralateral quadrants of the LV myocardium was similar between patients with MR and normal subjects. In conclusion, moderate to severe MR does not cause LV dyssynchrony in patients with LV dilatation and normal LVEF. Thus, cardiac resynchronization therapy in the absence of LV dyssynchrony may not decrease the severity of MR.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Cardiac Volume - physiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Coronary vessels</subject><subject>Disease Progression</subject><subject>Effects</subject><subject>Electrocardiography</subject><subject>Endocardial and cardiac valvular diseases</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart</subject><subject>Heart Ventricles - pathology</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Mitral Valve Insufficiency - diagnosis</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Prognosis</subject><subject>Severity of Illness Index</subject><subject>Stroke Volume - physiology</subject><subject>Therapy</subject><subject>Ventricular Dysfunction, Left - diagnosis</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNqFkluL1TAQgIso7nH1JyhF0LfWSZPm8uIi63qBI4qrvobsdLKm9rRr0grn35vDKS7sixAIgW8mM99MUTxlUDNg8lVfu12PLnZ1A6Bq4DVofa_YMK1MxQzj94sNADSVYcKcFI9S6vOTsVY-LE6YkkZpzjfF2wvvCedy8uWXGHYu7stPYY5uKL_S9RKvw-zmMI1lPlvyc_mDxjkGXAYXy8v9iD_jNO4fFw-8GxI9We_T4vu7i2_nH6rt5_cfz99sKxSqnSsOrQEj0JH2CCBE1yC2nfFMcU1OX0lOTKHBjgF2ipNQzDsneCekdA75afHymPcmTr8XSrPdhYQ0DG6kaUlWaialFjqDz--A_bTEMddmGw5c6rYRGWqPEMYppUje3hwNWAb24Nj2dnVsD44tcJsd57hna_LlakfdbdQqNQMvVsAldIOPbsSQbjmTx9I2MnNnR46ysz-Bok0YaETqQswzsd0U_lvK6zsZcAhjyJ_-oj2lf00zmxoL9vKwEId9AAVguGb8L9xRsOQ</recordid><startdate>20070815</startdate><enddate>20070815</enddate><creator>Denney, Thomas S., PhD</creator><creator>Nagaraj, Hosakote M., MD</creator><creator>Lloyd, Steven G., MD, PhD</creator><creator>Aban, Inmaculada, PhD</creator><creator>Corros, Cecilia, MD</creator><creator>Seghatol-Eslami, Frank, MD</creator><creator>McGiffin, David C., MD</creator><creator>Dell’Italia, Louis J., MD</creator><creator>Gupta, Himanshu, MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20070815</creationdate><title>Effect of Primary Mitral Regurgitation on Left Ventricular Synchrony</title><author>Denney, Thomas S., PhD ; Nagaraj, Hosakote M., MD ; Lloyd, Steven G., MD, PhD ; Aban, Inmaculada, PhD ; Corros, Cecilia, MD ; Seghatol-Eslami, Frank, MD ; McGiffin, David C., MD ; Dell’Italia, Louis J., MD ; Gupta, Himanshu, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c475t-3059094cae8fc0044d2cc5d9f1738ea8b63e17c9cd10cd73e471faa43d466aac3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Cardiac Volume - physiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Coronary vessels</topic><topic>Disease Progression</topic><topic>Effects</topic><topic>Electrocardiography</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart</topic><topic>Heart Ventricles - pathology</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Mitral Valve Insufficiency - diagnosis</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Prognosis</topic><topic>Severity of Illness Index</topic><topic>Stroke Volume - physiology</topic><topic>Therapy</topic><topic>Ventricular Dysfunction, Left - diagnosis</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Denney, Thomas S., PhD</creatorcontrib><creatorcontrib>Nagaraj, Hosakote M., MD</creatorcontrib><creatorcontrib>Lloyd, Steven G., MD, PhD</creatorcontrib><creatorcontrib>Aban, Inmaculada, PhD</creatorcontrib><creatorcontrib>Corros, Cecilia, MD</creatorcontrib><creatorcontrib>Seghatol-Eslami, Frank, MD</creatorcontrib><creatorcontrib>McGiffin, David C., MD</creatorcontrib><creatorcontrib>Dell’Italia, Louis J., MD</creatorcontrib><creatorcontrib>Gupta, Himanshu, MD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Denney, Thomas S., PhD</au><au>Nagaraj, Hosakote M., MD</au><au>Lloyd, Steven G., MD, PhD</au><au>Aban, Inmaculada, PhD</au><au>Corros, Cecilia, MD</au><au>Seghatol-Eslami, Frank, MD</au><au>McGiffin, David C., MD</au><au>Dell’Italia, Louis J., MD</au><au>Gupta, Himanshu, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Primary Mitral Regurgitation on Left Ventricular Synchrony</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2007-08-15</date><risdate>2007</risdate><volume>100</volume><issue>4</issue><spage>707</spage><epage>711</epage><pages>707-711</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>Mitral regurgitation (MR) promotes left ventricular (LV) dilatation and eccentric remodeling. In the presence of LV dyssynchrony and heart failure, cardiac resynchronization therapy decreases the severity of MR. Whether primary MR can cause LV dyssynchrony is unknown. We investigated whether moderate to severe primary MR causes LV dyssynchrony in the presence of LV dilation and an ejection fraction (EF) >55%. We studied 37 normal subjects and 22 patients with moderate to severe MR and no coronary artery disease. Electrocardiographically gated cine and tagged cardiac magnetic resonance imaging was performed. Two-dimensional, maximum-circumferential shortening strain and time-to-peak strain (TTPS) were computed using harmonic-phase analysis of tagged magnetic resonance imaging. LV dyssynchrony was assessed by comparing TTPS delay of various LV quadrants and TTPS dispersion among the contralateral quadrants in patients with MR and normal subjects. Statistical comparison was done using a generalized linear model for repeated measurements. LV end-diastolic and LV end-systolic volumes were significantly larger in patients with MR versus normal subjects (207 ± 11 vs 130 ± 4 and 73 ± 5 vs 47 ± 2 ml, p <0.001). LVEF did not differ in patients with MR and normal subjects. The difference in the TTPS among various quadrants and the dispersion among the contralateral quadrants of the LV myocardium was similar between patients with MR and normal subjects. In conclusion, moderate to severe MR does not cause LV dyssynchrony in patients with LV dilatation and normal LVEF. Thus, cardiac resynchronization therapy in the absence of LV dyssynchrony may not decrease the severity of MR.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>17697833</pmid><doi>10.1016/j.amjcard.2007.03.088</doi><tpages>5</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences Cardiac Volume - physiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Coronary vessels Disease Progression Effects Electrocardiography Endocardial and cardiac valvular diseases Female Follow-Up Studies Heart Heart Ventricles - pathology Heart Ventricles - physiopathology Humans Magnetic Resonance Imaging Male Medical sciences Middle Aged Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - diagnosis Mitral Valve Insufficiency - physiopathology NMR Nuclear magnetic resonance Prognosis Severity of Illness Index Stroke Volume - physiology Therapy Ventricular Dysfunction, Left - diagnosis Ventricular Dysfunction, Left - etiology Ventricular Dysfunction, Left - physiopathology |
| title | Effect of Primary Mitral Regurgitation on Left Ventricular Synchrony |
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