Impact of chronic organic Mitral Regurgitation on Right Ventricular Diastolic Function using Doppler echocardiographic study in multi cardiac center in Baghdad
Paper Details
Impact of chronic organic Mitral Regurgitation on Right Ventricular Diastolic Function using Doppler echocardiographic study in multi cardiac center in Baghdad
Abstract
To study the effect of left ventricular volume overload on right ventricular diastolic function by Doppler echocardiography in patients with chronic organic compensated mitral regurgitation. A cross-sectional study held in multi cardiac center in Baghdad from April 2015 to June 2016. Patients categorized in to two groups; Thirty-one were without pulmonary hypertension (group I, mean age 32±7.1 years) and thirty of patients were with pulmonary hypertension (group II, mean age 36.1±5.7years). All of them compared with sixty-one healthy individuals serving as a control group (group III, mean age 32.1±6.6 years). Transthoracic echocardiography (multiple views) M-mode, Two-dimensional and Doppler were done for all groups of study. Conventional and tissue Doppler echocardiographic assessment of right ventricular diastolic function revealed impairment in up to 44.3% of patients, (19.4% in group I vs 70% in group II, P<0.001). Patients had lower right ventricular E-wave velocity, lower E/A ratio, and prolonged right ventricular isovolumic relaxation time compared to control. Tissue Doppler analysis showed lower E’, and lower E’/A’ ratio. All changes were statistically significant at P < 0.001. Patients with pulmonary hypertension were older with higher E/E’ ratio in comparison to the other two groups (5.79±1.75 in group II vs 3.91±0.41, 4.08±0.93 in group III and I, respectively, P <0.001). Right ventricular diastolic function is frequently impaired in patients with chronic organic compensated mitral regurgitation. Early identification of such changes by Doppler echocardiography might help in identifying patients who need more aggressive therapy early on in the disease process.
Alexopoulos D, Lazam C, Borrico S, Fiedler L, Ambrose J. 1989. Isolated chronic mitral regurgitation with preserved systolic left ventricular function and severe pulmonary hypertension. JACC, 14, 319-322.
Baker BJ, Wilen MM, Boyd CM, Dinh H, Francisa JA. 1984. Relation of right ventricular ejection fraction to exercise capacity of patients with chronic left ventricular failure, American Journal of Cardiology 54, 596-599.
Borer JS, Hochreiter CA, Supino PG, Herrold EM, Krieger KH, Isom OW. 2002. Importance of right ventricular performance measurement in selecting asymptomatic patients with mitral regurgitation for valve surgery, Advances in Cardiology 39, 144-152.
Bristow JD, Morris JF, Kloster FE. 1966. Hemodynamics of cor pulmonale. Progress in Cardiovascular Diseases 9, 239-258.
Celik M, Yalcinkaya E, Yuksel UC. 2015. The effect of age on right ventricular diastolic function in healthy subjects undergoing treadmill exercise test, Echocardiography, 32(3), 436-442.
Chuwa-Tei MD, Karl S, Dujardin MD, David O, Hodge MS, Kent RB, Michael D, McGoon MDA, Jamil-Tajik MD, James B, Seward MD. 1996. Doppler echocardiographic index for assessment of global right ventricular function, Journal of the American Society of Echocardiography, 9(6), 838-847.
Davidson WRJR, Fee EC. 1990. Influence of aging on pulmonary hemodynamic in a population free of coronary artery disease. American Journal of Cardiology 65, 1454–1458.
De-Castro S, Cavarretta E, Milan A. 2008. Usefulness of tricuspid annular velocity in identifying global RV dysfunction in patients with primary pulmonary hypertension: A comparison with 3D echo-derived right ventricular ejection fraction. Echocardiography 25(3), 289–293.
Dib JC, Abergel E, Rovani C. 1997. The age of the patient should be taken into account when interpreting Doppler assessed pulmonary artery pressures. Journal of American Society, Echocardiography 10, 72–73.
Di-Mauro M, Calafiore AM, Penco M. 2007. Mitral valve repair for dilated cardiomyopathy: Predictive role of right ventricular dysfunction. European Heart Journal, 28, 2510–2516.
Enger R, Ray R, Higgins CB. 1982. Clinical assessment and follow up of functional capacity in patients with chronic congestive cardiomyopathy. American Journal of Cardiology, 49, 1832-1837.
Grifoni S, Iacopo O, Cecchini P, Berni G. 2000. Short term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction, Circulation 101(24), 2817-2822. http://dx.doi.org/10.1161/01.CIR.101.24.2817
Hirakawa S, Ito H, Sakai A, Wakabayashi A. 1981. Estimation of the compliance of the human pulmonary “venous” system from pulmonary artery wedge pressure tracings. Japanese Circulation Journal 45(1), 15- 23.
Lang IM, Plank C, Sadushi-Kolici R, Jakowitsch J, Klepetko W, Maurer G. 2010. Imaging in pulmonary hypertension. JACC Cardiovasc Imaging 3, 1287-1295.
Leonardo AM, Zornoff MD, Hicham SMD, Marc A, Pfeffer MD. 2002. Right ventricular dysfunction and risk of heart failure and mortality after myocardial infarction, Journal of the American College of Cardiology, 39, 1450–1455.
Mangion JR. 2010. Right ventricular imaging by two-dimensional and three dimensional echocardiography, Current Opinion in Cardiology, 22, 423–429.
Marangoni S, Scalvini S, Schena M, Vitacca M, Quadri A, Levi G. 1992. Right ventricular diastolic function in chronic obstructive lung disease. European Respiration Journal 5, 438-443.
Miller D, Farah MG, Liner A. 2004. The relation between quantitative right ventricular ejection fraction and indices of tricuspid annular motion and myocardial performance, Journal of American Society Echocardiography 17, 443–447.
Meluzı́n L, Špinarová L, Dušek L, Toman J, Hude P, Krejčı́ J. 2003. Prognostic importance of the right ventricular function assessed by Doppler tissue imaging. European Journal of Echocardiography, 4(4), 262–271, https://doi.org/10.1016/S1525-2167(02)00171-3
Peyman N, Fadi A, Tyler B, Milind YD. 2015. Impact of Duration of Mitral Regurgitation on Outcomes in Asymptomatic Patients With Myxomatous Mitral Valve Undergoing Exercise Stress Echocardiography. Journal of the American Heart Association 4(2), 1-9. http://dx.doi.org/10.1161/JAHA.114.001348.
Roberto M, Lang MD, Luigi P, Badano MD, Victor MA, Jonathan A. 2015. Recommendations for cardiac chamber Quantification by Echocardiography and the European Association of Cardiovascular Imaging, Journal of the American Society of Echocardiography, 28, 1-39.
Rosen SE, Borer JS, Hochreiter C, Supino P, Roman MJ. 1994. Natural history of the asymptomatic/minimally symptomatic patient with severe mitral regurgitation secondary to mitral valve prolapse and normal right and left ventricular performance. American Journal of Cardiology, 74, 374-380.
Rudski LG, Lai WW, Afilalo J, Hua L, Handschumacher MD. Chandrasekaran K, Solomon SD, Louie EK, Schiller NB. 2010. Guidelines for the Echocardiographic assessment Assessment of the right heart in adults: Areport from the American Society of Echocardiography, endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography, Journal of the American Society of Echocardiography 23, 685-713. http://dx.doi.org/10.1016/j.echo.2010.05.010.
Sade LE, Gulmez O, Eroglu S. 2007. Noninvasive estimation of right ventricular filling pressure by ratio of early tricuspid inflow to annular diastolic velocity in patients with and without recent cardiac surgery, Journal of American Society, Echocardiography 20, 982–988.
Serra W, Chetta A, Santilli D, Mozzani F, Dall Aglio PP, Olivieri D. 2010. Echoardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis. Cardiovascular Ultrasound 8, 25. http://dx.doi.org/10.1186/1476-7120-8-25.
Schiller NB, Shah PM, Crawford M. 1989. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of echocardiography Committee on standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms, Journal of American Society Echocardiography 2, 358-367.
Teichholz LE, kreulen T, Herman MV, Gorlin R. 1976. Problems in echocardiogrphic volume determinations: echocardiographic- angiographic correlations in the presence of absence of asynergy, American Journal of Cardiology 37, 7-11.
Ueti O, Camargo E, Ueti A. 2002. Assessment of right ventricular function with Doppler echocardiographic indices derived from tricuspid annular motion: Comparison with radionuclide angiography. Heart, 88, 244–248.
Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA. 2012. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on 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 33, 2451-2496.
Willis J, Augustine D, Shah R. 2012. Right ventricular normal measurements: time to index?, Journal of American Society Echocardiography 25, 1259–1267.
Wranne B, Pinto FJ, Hammarstrom E, St-Goar FG, Puryear J, Popp RL. 1991. Abnormal right heart filling after cardiac surgery: time course and mechanisms. British Heart Journal 66, 435-442.
Attaa K. Taha, Ghazi F. Al-haji, Ghassan Thabet Saeed, 2018. Impact of chronic organic Mitral Regurgitation on Right Ventricular Diastolic Function using Doppler echocardiographic study in multi cardiac center in Baghdad. Int. J. Biosci., 13(4), 92-101.
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