Enbiya AKSAKAL, Serdar SEVİMLİ, Hanefi Yekta GÜRLERTOP, Mehmet Ali ELBEY, Muhammed Hakan TAŞ, Fuat GÜNDOĞDU, Mustafa Kemal EROL, Şule KARAKELLEOĞLU

Assessment of the left atrial longitudinal myocardial function by Assessment of the left atrial longitudinal myocardial function by the strain and strain rate echocardiography in patients with rheumatic mitral stenosis*

To evaluate the regional left atrial (LA) myocardial functions and time to peak deformations by the longitudinal strain (S) and strain rate (Sr) echocardiography in isolated mitral stenosis (MS) patients for 3 LA periods (contractile, reservoir, and conduit periods). Materials and methods: Included in the study were 30 MS patients and 30 healthy controls. Longitudinal peak S and Sr indices, time to peak S and time to peak Sr, and systolic and diastolic velocities were measured from the color Doppler myocardial imaging data, for each LA period. Results: For all 3 periods, all of the segment S values and most of the segment Sr values were significantly lower in the patients than in the controls (P < 0.0001 and P < 0.05, respectively). There were no significant differences between the groups in terms of velocities. Time to peak S in the contractile and conduit periods was significantly higher in the patients than in the controls, in most of the segments (P < 0.05). Time to peak Sr was significantly higher in the patients than in the controls, in all of the periods in all of the segments (P < 0.05) except for mid-septal segments. Conclusion: This study demonstrated that LA longitudinal myocardial functions were impaired in MS patients with S/Sr echocardiography. Our study is the first to demonstrate prolonged time to peak S/Sr of the LA in rheumatic MS. This condition might be an additional factor in the deterioration of regional LA myocardial function in MS patients.

Anahtar Kelimeler:

Key words: Mitral stenosis, echocardiography, left atrial functions, longitudinal strain, strain rate

Assessment of the left atrial longitudinal myocardial function by Assessment of the left atrial longitudinal myocardial function by the strain and strain rate echocardiography in patients with rheumatic mitral stenosis*

Keywords:

Key words: Mitral stenosis, echocardiography, left atrial functions, longitudinal strain, strain rate,

PDF

___

Otto CM, Bonow RO. Valvular heart disease. In: Libby P, Bonow RO, Mann DL, Zipes DP, Braunwald E, editors. Braunwald’s heart disease: a textbook of cardiovascular medicine, 8th ed. Saunders Elsevier, Philadelphia, 2008. p. 1646-57.
Sirbu C, Herbots L, D’hooge J, Claus P, Marciniak A, Langeland T et al. Feasibility of strain and strain rate imaging for the assessment of regional left atrial deformation: a study in normal subjects. Eur J Echocardiogr 2006; 7: 199-208.
Tops LF, van der Wall EE, Schalij MJ, Bax JJ. Multi-modality imaging to assess left atrial size, anatomy and function. Heart 2007; 93: 1461-70.
Kircher B, Abbott J, Pau S, Gould R, Himelman R, Higgins C et al. Left atrial volume determination by biplane two- dimensional echocardiography: validation by cine computed tomography. Am Heart J 1991; 121: 864-71.
Matsuoka H, Hamada M, Honda T, Kobayashi T, Suzuki M, Ohtani T et al. Measurement of cardiac chamber volumes by cine magnetic resonance imaging. Angiology 1993; 44: 321-7.
Marmor A, Frankel A, Blondeheim DS, Satinger A, Front D. Scintigraphic assessment of atrial function in patients with longstanding hypertension. Radiology 1984; 151: 483-6.
Pislaru C, Abraham TP, Belohlavek M. Strain and strain rate echocardiography. Curr Opin Cardiol 2002; 17: 443-54.
Wang T, Wang M, Fung JW, Yip GW, Zhang Y, Ho PP et al. Atrial strain rate echocardiography can predict success or failure of cardioversion for atrial fi brillation: a combined transthoracic tissue Doppler and transoesophageal imaging study. Int J Cardiol 2007; 114: 202-9.
Kokubu N, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T et al. Noninvasive assessment of left atrial function by strain rate imaging in patients with hypertension: a possible benefi cial eff ect of renin-angiotensin system inhibition on left atrial function. Hypertens Res 2007; 30: 13-21.
Th omas L, McKay T, Byth K, Marwick TH. Abnormalities of left atrial function aft er cardioversion: an atrial strain rate study. Heart 2007; 93: 89-95.
Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al. Recommendations for chamber quantifi cation: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantifi cation 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: 1440-63.
Tanabe T, Deguchi Y, Handa S, Takahashi A, Fukushi H. Longer longitudinal atrial dimension in patients with idiopathic paroxysmal atrial fi brillation: a possible cause of atrial fi brillation. Am Heart J 2001; 142: 669-78.
Barbier P, Alioto G, Guazzi MD. Left atrial function and ventricular fi lling in hypertensive patients with paroxysmal atrial fi brillation. J Am Coll Cardiol 1994; 24: 165-70.
D’hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr 2000; 1: 154-70.
Muranaka A, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T et al. Quantitative assessment of left ventricular and left atrial functions by strain rate imaging in diabetic patients with and without hypertension. Echocardiography 2009; 26: 262-71.
Clarkson PB, Wheeldon NM, Lim PO, Pringle SD, MacDonald TM. Left atrial size and function: assessment using echocardiographic automatic boundary detection. Br Heart J 1995; 74: 664-70.
Waggoner AD, Barzilai B, Miller JG, Pérez JE. On-line assessment of left atrial area and function by echocardiographic automatic boundary detection. Circulation 1993; 88: 1142-9.
Feinberg MS, Waggoner AD, Kater KM, Cox JL, Pérez JE. Echocardiographic automatic boundary detection to measure left atrial function aft er the maze procedure. J Am Soc Echocardiogr 1995; 8: 139-48.
Hesse B, Schuele SU, Th amilasaran M, Th omas J, Rodriguez L. A rapid method to quantify left atrial contractile function: Doppler tissue imaging of the mitral annulus during atrial systole. Eur J Echocardiogr 2004; 5: 86-92.
Leung DY, Boyd A, Ng AA, Chi C, Th omas L. Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 2008; 156: 1056-64.
Inaba Y, Yuda S, Kobayashi N, Hashimoto A, Uno K, Nakata T et al. Strain rate imaging for noninvasive functional quantifi cation of the left atrium: comparative studies in controls and patients with atrial fi brillation. J Am Soc Echocardiogr 2005; 18: 729- 36.
Ozdemir AO, Kaya CT, Ozcan OU, Ozdol C, Candemir B, Turhan S et al. Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis. Int J Cardiovasc Imaging 2010; 26: 397-404.
Lee YS, Lee CP. Ultrastructural pathological study of left ventricular myocardium in patients with isolated rheumatic mitral stenosis with normal or abnormal left ventricular function. Jpn Heart J 1990; 31: 435-48.
Sengupta PP, Mohan JC, Mehta V, Kaul UA, Trehan VK, Arora R et al. Eff ects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: quantitative assessment by tissue velocity imaging. J Am Soc Echocardiogr 2004; 17: 824-8.