Severe aortic valve stenosis with preserved and reduced systolic left ventricular function: diagnostic usefulness of the Tei index.

BACKGROUND: In patients with severe aortic valve stenosis (AS), the onset of heart failure is associated with increased mortality and higher operative risk. Heart failure may result from either systolic, diastolic, or "overall" left ventricular dysfunction. The index "isovolumic contraction time and isovolumic relaxation time divided by ejection time" was shown to be a sensitive indicator of "overall" cardiac dysfunction in patients with dilated cardiomyopathy and cardiac amyloidosis. We sought to define the role of the Tei index in patients with severe AS and to validate this index against conventional measures of systolic and diastolic LV function. PATIENTS AND METHODS: Fifty-three participants underwent left heart catheterization for invasive measurement of LV end-diastolic pressure as a marker of diastolic function: 10 AS patients (valve orifice 0.6 +/- 0.2 qcm) with depressed systolic LV function (defined by LV ejection fraction < or = 45% [mean 32% +/- 8%], 7 male/3 female, 72 +/- 10 years old, DAS group), 22 AS patients (valve orifice 0.7 +/- 0.2 qcm) with preserved systolic LV function (ejection fraction > 45% [mean 55% +/- 6%], 13 male/9 female, 71 +/- 11 years old, PAS group) and 21 asymptomatic control participants (ejection fraction > 45% [mean 62% +/- 8%], 14 male/7 female, 66 +/- 8 years old, CON group). Within 24 hours from catheterization, conventional 2-dimensional and Doppler echocardiographic examination including measurement of the Tei index was performed. RESULTS: LV end-diastolic pressure was elevated in the DAS and in the PAS group in comparison with control participants (32 +/- 6 mm Hg and 22 +/- 7 mm Hg vs 11 +/- 4 mm Hg, respectively, P <.01 for both comparisons). DAS patients were in a higher New York Heart Association functional class than PAS patients (3.2 +/- 0.4 vs 2.2 +/- 0.4, P <.001) The Tei index was easily and reproducibly obtained in all study participants. In the DAS group, isovolumic contraction time was prolonged and ejection time was shortened in comparison with the CON group (102 +/- 20 ms vs 52 +/- 15 ms, P <.01; and 235 +/- 44 ms vs 316 +/- 45 ms, P <.01), resulting in a significantly increased Tei index (0.78 +/- 0.28 vs 0.40 +/- 0.11, P <.01). In the PAS group, isovolumic relaxation time was shortened (62 +/- 18 ms vs 81 +/- 26 ms for the CON group, P <.01) and ejection time was prolonged (335 +/- 34 ms vs 316 +/- 45 ms for the CON group, P <.05), resulting in a decreased Tei index (0.29 +/- 0.12 vs 0.40 +/- 0.11, P <.05). Receiver operating characteristic curve analysis for the Tei index yielded an area under the curve of 0.98 +/- 0.03 for separating DAS and PAS patients. Using a Tei index greater than 0.42 as a cutoff, DAS patients were identified with a sensitivity of 100% and a specificity of 91%. CONCLUSION: The Tei index is significantly increased in patients with severe AS and depressed overall cardiac LV function. In AS patients with predominant diastolic dysfunction, in whom systolic function is preserved, the index is decreased in comparison with control patients. The index differentiates between symptomatic AS patients with depressed and less symptomatic AS patients with preserved systolic LV function, and may thus provide relevant information in the work-up and care of such patients.     

心脏手术前后Tei指数及脑钠肽变化的研究

目的 探讨心脏瓣膜置换术前后Tei指数及心脏围手术期血清脑钠素(BNP)的变化规律及其意义.方法 (1)对86例行主动脉瓣或二尖瓣置换术的患者,分别于术前1个月至1周、术后1周至1个月测量Tei指数;(2)对20例在非体外循环下行冠状动脉搭桥术的冠心病患者和30例在体外循环下行心脏瓣膜置换术的风心病患者,分别于术前、术后即刻、术后24 h、3 d和7 d测量血清BNP浓度.结果 (1)主动脉瓣狭窄、主动脉瓣关闭不全及二尖瓣狭窄患者术后Tei指数都有不同程度增加,自身手术前后相比差异有统计学意义(P＜0.05或P＜0.01),而二尖瓣关闭不全患者术后Tei指数降低,但手术前后差异无统计学意义(P＞0.05);(2)冠心病和风心病患者术前血清BNP浓度均明显高于正常组(P＜0.01),术后即刻与术前相似,此后迅速上升,24 h达到高峰,然后开始下降,术后7 d尚未降到术前水平;血清BNP浓度在体外循环和非体外循环下心脏手术中的变化相似,体外循环期间BNP没有进一步升高.结论 心脏瓣膜置换术后Tei指数有明显变化,因此在评价瓣膜病患者的左心室功能时应考虑到瓣膜功能不全对Tei指数的影响;血清BNP浓度在体外循环和非体外循环下心脏手术中的变化相似,体外循环期间BNP没有进一步升高.     

Doppler tissue analysis of mitral annular velocities: evidence for systolic abnormalities in patients with diastolic heart failure.

BACKGROUND: The presence of signs and symptoms of heart failure (HF), abnormal diastolic function and an ejection fraction > 45%, have been defined as diastolic HF (DHF). However, a cut-off value of 45% for ejection fraction seems arbitrary as mild systolic dysfunction may be overlooked. It was the goal of this study to assess the additive information derived from Doppler tissue imaging for patients with DHF. METHODS: As a measure of left ventricular (LV) long-axis function, systolic and diastolic velocities of the mitral annulus (peak, peak early, and peak late) derived from pulsed Doppler tissue imaging were assessed in 36 asymptomatic control subjects, 36 patients with DHF, and 35 patients with systolic HF (SHF). As a measure of overall LV performance, the Tei index (isovolumic contraction time and isovolumic relaxation time divided by ejection time) was assessed. RESULTS: In the DHF group, peak systolic annular velocity was reduced (7.1 +/- 1.2 cm/s) as compared with the control group (9.0 +/- 1.2 cm/s, P <.05), and was even lower in the SHF group (5.0 +/- 0.7 cm/s, P <.01 SHF group vs DHF/control groups). The Tei index was increased in the DHF group (0.53 +/- 0.14) in comparison with the control group (0.39 +/- 0.07, P <.05), and was highest in the SHF group (0.94 +/- 0.43, P <.01 SHF group vs control/DHF groups). Using peak systolic annular velocity < 7.95 cm/s as a cut-off value (derived from receiver operating characteristic curve analysis), patients with DHF were separated from control subjects with a sensitivity of 83% and a specificity of 83%. A Tei index > 0.43 separated patients with DHF and control subjects with a sensitivity of 79% and a specificity of 72%. CONCLUSION: Systolic long-axis LV function is also impaired in patients with DHF, resulting in feasible diagnosis of DHF by Doppler tissue imaging analysis of LV long-axis function and overall LV function with the Tei index.     

Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis (long-term follow-up: 8 years)

Carrying out a mitral valve replacement (MVR) while preserving all chordae tendineae in patients with mitral regurgitation has been proven beneficial to the left ventricular performance. To evaluate the effectiveness of this technique in patients with mitral stenosis, a comparison of the echocardiographic data between patients who were operated on using this technique (Group Preservation = GroupP, n = 15), and those operated on using the conventional method of MVR (Group Conventional = GroupC, n = 15) was made. All patients were examined before surgery, 6 months after surgery and 8 years after surgery. The study population was limited to patients who had no evidence of coronary artery disease, aortic stenosis and/or regurgitation and patients who had pure mitral stenosis. Echocardiographic measurements obtained both 6 months and 8 years postoperatively revealed a significant decrease in the left ventricular ejection fraction in GroupC (61.33+/-9.29% preoperatively, 53.2+/-10.3% postoperatively). The difference between the decrease in the left ventricular ejection fraction of the two groups was statistically significant (-0.71+/-6.28% in GroupP, -8.07+/-13.35% in GroupC). There was no evidence of prosthetic valve dysfunction and no operative deaths. Two patients died in GroupP, 3 patients died in GroupC within the 8 year period. The conclusion was reached, that if suitable, mitral valve replacement while preserving the chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.     

全方位M-型与普通M-型超声对比评价左室Tei指数的临床研究

目的 本研究目的旨在比较脉冲多普勒、普通M-型、全方位M-型超声3种方法所得心肌作功指数（Tei指数）的相关性,试图探索一种简便、有效、实用的检测方法。 方法 70例住院患者接受检查。应用脉冲多普勒分别采集二尖瓣口和主动脉瓣口血流频谱,应用普通M-型超声分别记录二尖瓣及主动脉瓣活动曲线,应用全方位M-型超声在同一心动周期内同时记录二尖瓣及主动脉瓣活动曲线,分别测量二尖瓣闭合至下一心动周期开放时间间期（a线）及主动脉瓣开放时间（b线）,计算Tei指数。 结果 普通M-型、全方位M-型与脉冲多普勒超声3种方法测得Tei指数之间的比较差异无统计学意义,且相关性好。 结论 全方位M-型是一种较为简便、理想的测定Tei指数的方法。     

Effects of percutaneous mitral commissurotomy on longitudinal left ventricular dynamics in mitral stenosis: quantitative assessment by tissue velocity imaging.

OBJECTIVE: We hypothesized that mitral annular velocities would improve immediately after relief of mitral stenosis and that serial assessment could be used as an index for quantifying functional changes after percutaneous mitral commissurotomy (PMC). METHODS: Longitudinal left ventricular annular velocities were quantified by spectral pulsed wave Doppler tissue velocity imaging in 25 patients (16 women; mean age [+/-SD], 29.2 +/- 8.6 years) who had isolated mitral stenosis and were in sinus rhythm, and were compared with 30 age- and sex-matched control subjects. Echocardiography was performed 1 to 24 hours before PMC and 48 to 72 hours after, and changes in velocities from the lateral and septal corners of the mitral annulus in early diastole, late diastole, isovolumic contraction, and ejection were recorded. RESULTS: Systolic and diastolic mitral annular velocities were significantly less in patients with mitral stenosis than in control subjects. After PMC, peak annular velocity of systolic excursion in ejection and peak annular velocity in early diastole showed significant improvement. The change in peak annular velocity in early diastole in the lateral wall correlated well with improvement in the mitral valve orifice area by planimetry (ratio of mitral valve orifice area, 1.92 +/- 0.42; ratio of peak annular velocity in early diastole, 1.36 +/- 0.22; r = 0.65; P <.001). CONCLUSION: Serial evaluation of changes in mitral annular velocities by Doppler tissue imaging aids clinical assessment of immediate improvement in left ventricular function after PMC.     

Temporal variations in effective orifice area during ejection in patients with valvular aortic stenosis.

Effective orifice area (EOA) is the standard index for assessing aortic stenosis (AS) severity. However, EOA varies during ejection and a single measurement at 1 ejection time point may not fully describe the hemodynamic severity of a stenotic aortic valve. We investigated whether the dynamic change in EOA during ejection differs between patients with severe AS (EOA /=80% of maximum EOA for a shorter duration during ejection compared with control patients (49 +/- 25 vs 64 +/- 14%, P =.05). EOA opening rate, time to maximum V(LVOT), time to maximum V(AS), and time to 80% of maximum EOA correlated with mean pressure gradient (r = -0.80, 0.63, 0.42, and 0.54, respectively, n = 45). Indices of ejection dynamics and valve kinetics differ in patients with AS and may provide further insight into the hemodynamic or physiologic severity of a stenotic aortic valve.     

Noninvasive differentiation of pseudonormal/restrictive from normal mitral flow by Tei index: a simultaneous echocardiography-catheterization study in patients with acute anteroseptal myocardial infarction.

BACKGROUND: Differentiation of pseudonormal/restrictive from normal mitral flow is still clinically problematic. Pseudonormal/restrictive flow is usually associated with left ventricular dysfunction, which can be detected by Doppler Tei index, combining systolic and diastolic function. Therefore, the purpose of this study was to test the feasibility of the Tei index to differentiate pseudonormal/restrictive from normal mitral flow. METHODS: In 26 patients with anteroseptal acute myocardial infarction and early diastolic mitral flow velocity (E) to late diastolic mitral flow velocity (A) ratio (E/A) > or = 1, left ventricular volumes; E and A; deceleration time of E; and the Tei index, defined as the sum of the isovolumic contraction and relaxation time divided by ejection time, were evaluated by Doppler echocardiography, and pulmonary capillary wedge pressure was measured by catheterization. Pseudonormal/restrictive mitral flow was defined as E/A > or = 1 associated with pulmonary capillary wedge pressure > 12 mm Hg. RESULTS: There were 19 and 7 patients with pseudonormal/restrictive and normal mitral flow, respectively. Among the indices of left ventricular function, the Tei index achieved the best correlation with pulmonary capillary wedge pressure (r(2) = 0.66, P <.0001). By setting the Tei index > or = 0.55 as the criteria for pseudonormal/restrictive mitral flow, this diagnosis had the sensitivity, specificity, and accuracy of 84%, 100%, and 88%, respectively. CONCLUSION: The Tei index allows noninvasive differentiation of pseudonormal/restrictive from normal mitral flow.     

Cardiorespiratory exercise capacity and its relation to a new Doppler index in children previously treated with anthracycline.

The purpose of this study was to assess the exercise capacity of patients treated with anthracycline and to evaluate the relation between the exercise capacity and a new Doppler index. The study patients consisted of 70 subjects: 41 healthy subjects and 29 who had been treated with various cumulative doses of anthracycline (range 45 to 873 mg per body surface area). The following conventional echocardiographic parameters were measured: rate-corrected mean velocity of fiber shortening (mVcfc), end-systolic wall stress (ESS), stress-velocity index, and early and late diastolic mitral inflow velocities and their ratio. A new Doppler index, the Tei index, was calculated as the sum of isovolumic contraction time and isovolumic relaxation time divided by the ejection time. Peak oxygen uptake (pVo(2)) and anaerobic threshold (AT) were measured during an upright bicycle exercise test. The pVo(2) and AT in the patient group were significantly lower than those in the control group (pVo(2): 22.0 +/- 3.7 versus 28.5 +/- 7.1 mL/min/kg; AT: 12.7 +/- 1.9 versus 17.3 +/- 4.3 mL/min/kg, respectively; P <.01). There were no significant differences in the mVcfc, ESS, stress-velocity index, E wave, A wave, or E/A wave ratio between the two groups. However, the mean Tei index of the patients was significantly greater than that of the controls (0.41 +/- 0.11 versus 0.33 +/- 0.04, P <.01). The pVo(2) and AT decreased significantly with an increase in the Tei index (r = -0.64 and -0.60, respectively; P <.01). A weak positive correlation was found between the AT and E/A wave ratio (r = 0.54, P <.05). However, no significant correlations were seen between the exercise parameters and the mVcfc, ESS, stress velocity index, or transmitral velocities. Our findings suggest that cardiopulmonary exercise testing revealed an inverse correlation between exercise capacity and the Tei index.     

超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值

目的探讨超声心动图在评估经导管主动脉瓣置换（TAVR）术前与术后心脏结构和功能改变中的应用价值。 方法回顾性选取2014年9月至2019年7月在复旦大学附属中山医院心内科行TAVR的重度主动脉瓣狭窄（SAS）患者47例。所有患者均于术前及术后6个月行经胸超声心动图检查并记录常规超声心动图参数和主动脉瓣相关参数,包括左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、后壁厚度（PWT）、肺动脉收缩压（PASP）、主动脉瓣最大跨瓣压差（AVPGmax）、主动脉瓣平均跨瓣压差（AVPGmean）、主动脉瓣有效瓣口面积（AVA）、左心室射血分数（LVEF）、主动脉根部内径（AORD）、左心房内径（LAD）,分析TAVR术前与术后的超声心动图参数变化。 结果与术前相比,术后47例患者的LVESD、IVST、PWT、PASP、AVPGmax、AVPGmean均明显减小,差异均有统计学意义（P均＜0.05）;AVA和LVEF均明显变大,差异均有统计学意义（P均＜0.05）。术后合并二尖瓣反流中度及以上或三尖瓣反流中度及以上的患者较术前明显减少（8例vs 3例,7例vs 2例）。 结论TAVR可纠正主动脉瓣狭窄,改善患者心功能。超声心动图相关参数有助于TAVR术后人工瓣膜及患者心脏结构功能的随访评估。     

Association of Doppler-derived myocardial performance index with albuminuria in patients with diabetes.

Albuminuria is a predictor of cardiovascular morbidity and mortality in patients with diabetes. In this study, the relationship of albuminuria with left ventricular function by using myocardial performance (Tei) index together with conventional function parameters was aimed to be examined. We studied 123 patients with diabetes but without obvious coronary artery disease and heart failure. The patients were divided into 3 groups: 50 with no albuminuria; 49 with microalbuminuria; and 24 with macroalbuminuria. The Tei index in the patients with diabetes was increased (0.59 +/- 0.12). A significant stepwise increase in the Tei index was seen from no albuminuria to macroalbuminuria (0.51 +/- 0.1, 0.61 +/- 0.1, and 0.7 +/- 0.08, respectively). Tei index was positively correlated with isovolumic relaxation time, isovolumic contraction time, the duration of diabetes, left ventricular mass index, the levels of fibrinogen, creatinine, total cholesterol, and low-density lipoprotein cholesterol. The association of amount of secreted albumin into urine with echocardiographic parameters (Tei index, ejection fraction, peak early and late transmitral filling velocity ratio, peak early transmitral filling velocity decelaration time, isovolumic relaxation time, left ventricle mass index) was evaluated by using regression analysis. It was observed that amount of albumin was significantly associated with only Tei index ( P = .001, B = 0.3).It was found that there was a strong relation between Tei index and albuminuria and also its degree. Therefore, it was concluded that Tei index may be a sensitive marker for diagnosis of ventricular dysfunction in patients with diabetes and prognosis of diabetes.     

组织多普勒成像Tei指数测量对扩张型心肌病患者左室功能的评价

目的探讨组织多普勒成像(TDI)测量Tei指数评价扩张型心肌病(DCM)患者左室功能的价值。方法应用TDI获取25例DCM患者二尖瓣环间隔侧及左侧壁两点的运动频谱,测量等容舒张期(IRT)、等容收缩期(ICT)、射血时间(ET),并计算TDI-Tei指数,并与健康对照组及传统脉冲多普勒显像所测值进行比较。结果TDI所测DCM患者IRT、ICT显著延长,ET显著缩短,而TDI-Tei指数显著增大,TDI与传统脉冲多普勒显像两种方法所测IRT、ICT、ET及Tei指数分别呈直线相关,而两种方法所测二尖瓣环室间隔侧与左侧壁的Tei指数平均值相关性最高。结论TDI技术可用于测量DCM患者左室Tei指数,并与传统脉冲多普勒显像所测值相关性好。     

Intraoperative transesophageal echocardiography in minimally invasive cardiac valve surgery.

The minimally invasive procedure is a new surgical technique that uses a small sternal incision. Because of limited surgical exposure, removal of intracavitary air and visual assessment of cardiac function are not possible. We studied the utility of intraoperative transesophageal echocardiography (IOE) before and after cardiopulmonary bypass in 112 patients (mean age 53.1 +/- 15.2 years, 74 males) who underwent minimally invasive valvular surgery. Surgical procedures included 52 isolated mitral valve procedures (49 repairs, 3 prostheses), 58 isolated aortic valve procedures (16 repairs, 26 prostheses, 16 homografts), and 2 combined aortic and mitral valve repairs. Prepump IOE was useful to confirm valve dysfunction and assist determination of arterial cannulation site. Postpump IOE identified intracardiac air in all patients, which was defined as extensive in 58 (52%) cases. Postoperatively, new left ventricular dysfunction was noted in 22 (20%) patients, more often in the group with extensive air by IOE (17 [30%] of 58 patients) compared with those without extensive air (5 [10%] of 54 patients, P =.01). Second pump runs were required in 7 (6%) of 112 patients: 3 cases of residual aortic regurgitation, 1 case of residual mitral regurgitation, and 3 cases with new ventricular dysfunction. No deaths occurred. We conclude that IOE is essential in minimally invasive valvular surgery because it detects problems that require immediate remedy. IOE allows real-time assessment of ventricular filling, ventricular and valvular function, and intracardiac air.     

Doppler evaluation of normalized peak filling rate in normal children and children with left ventricular outflow obstruction.

To evaluate the early diastolic peak filling rate of the left ventricle, three groups of children (normal children, patients with aortic valvular stenosis, and patients with aortic coarctation) were examined with the peak filling rate normalized to stroke volume calculated from the mitral valve inflow Doppler recording as the peak E velocity divided by the velocity time integral. The normal value for this index in children was 6.78 +/- 0.99 SV/sec and did not vary with age, weight, body surface area, or heart rate. Compared with normal subjects, both patients with aortic stenosis and patients with coarctation had increased left ventricular mass, but patients with aortic stenosis had decreased normalized peak filling rates (5.3 +/- 0.84 SV/sec, p < 0.01), while patients with coarctation had normal rates (6.79 +/- 0.98 SV/sec, p = 0.97). Compared with patients with aortic coarctation, patients with aortic stenosis had higher Doppler gradients. Thus the Doppler index of peak filling rate normalized to stroke volume is particularly useful in children because it is independent of heart rate, age, weight, and body surface area. Patients with coarctation may have normal peak filling rates normalized to stroke volume despite increased left ventricular mass because of milder obstruction or better coronary artery perfusion compared with that of patients with aortic stenosis.     

Effect of right ventricular apex pacing on the Tei index and brain natriuretic peptide in patients with a dual-chamber pacemaker

BACKGROUND: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP). METHODS: Doppler echocardiographic study and BNP measurements were performed at follow-up (mean intervals from pacemaker implantation, 44+/-75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n=30; atrioventricular block, n=46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24-hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n=46 patients with RVA pacing>or=50% of the time, percentage of ventricular paced 100+/-2%; sensing group, n=30, patients with RVA pacing<50% of the time, percentage of ventricular paced 3+/-6%. RESULTS: There was no significant difference in mean heart rate derived from 24-hour ambulatory ECG recordings when comparing the two groups (66+/-11 bpm vs 69+/-8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67+/-0.17 vs 0.45+/-0.09, P<0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34+/-0.19 vs 0.25+/-0.09, P=0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40+/-47 pg/mL vs 18+/-11 pg/mL, P=0.017). With the exception of LV diastolic dimension (49+/-5 mm vs 45+/-5 mm, P=0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35+/-8 mm vs 34+/-5 mm), LA volume (51+/-27 cm3 vs 40+/-21 cm3), LV systolic dimension (30+/-6 mm vs 29+/-7 mm), or ejection fraction (66+/-9% vs 63+/-11%), when comparing the two groups. CONCLUSIONS: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers.     

Tei index 值与心功能不全程度之间的关系

我们用Ｄｏｐｐｌｅｒ法测得一种指标,即从房室瓣血流及心室身血血流频谱中,求得Ｔｅｉ ｉｎｄｅｘ值。并与临床心功能对比,讨论该指标的意义。结果该指数与心功能之间有一定关系,在人群间的重迭程度小,并且,指数与心率,二尖瓣返流程度无明显关系。     

Prevalence and Natural History of Mitral Annulus Calcification and Related Valve Dysfunction

ObjectiveTo evaluate the prevalence and natural history of mitral annulus calcification (MAC) and associated mitral valve dysfunction (MVD) in patients undergoing clinically indicated echocardiography.MethodsA retrospective review was conducted of all adults who underwent echocardiography in 2015. Mitral valve dysfunction was defined as mitral regurgitation or mitral stenosis (MS) of moderate or greater severity. All-cause mortality during 3.0 (0.4 to 4.2) years of follow-up was compared between groups stratified according to the presence of MAC or MVD.ResultsOf 24,414 evaluated patients, 5502 (23%) had MAC. Patients with MAC were older (75±10 years vs 60±16 years; P<.001) and more frequently had MVD (MS: 6.6% vs 0.5% [P<.001]; mitral regurgitation without MS: 9.5% vs 6.1% [P<.001]). Associated with MS in patients with MAC were aortic valve dysfunction, female sex, chest irradiation, renal dysfunction, and coronary artery disease. Kaplan-Meier 1-year survival was 76% in MAC+/MVD+, 87% in MAC+/MVD?, 86% in MAC?/MVD+, and 92% in MAC?/MVD?. Adjusted for age, diabetes, renal dysfunction, cancer, chest irradiation, ejection fraction below 50%, aortic stenosis, tricuspid regurgitation, and pulmonary hypertension, MAC was associated with higher mortality during follow-up (adjusted hazard ratio, 1.40; 95% CI, 1.31 to 1.49; P<.001); MVD was associated with even higher mortality in patients with MAC (adjusted hazard ratio, 1.79; 95% CI, 1.58 to 2.01; P<.001). There was no significant interaction between MAC and MVD for mortality (P=.10).ConclusionIn a large cohort of adults undergoing echocardiography, the prevalence of MAC was 23%. Mitral valve dysfunction was more than twice as prevalent in patients with MAC. Adjusted mortality was increased in patients with MAC and worse with both MAC and MVD.     

Myocardial function in severe aortic stenosis before and after aortic valve replacement: a Doppler tissue imaging study.

BACKGROUND: The aim of the study was to assess the value of Pulsed-wave Doppler tissue imaging (DTI) in assessing diastolic and systolic function in patients with severe aortic value stenosis. METHODS: Thirty-five patients with aortic stenosis (AS) (valve orifice < or = 1 cm 2 , mean age 71.8 +/- 6.2) and 35 comparable healthy subjects were studied. All subjects performed conventional 2-dimensional Doppler echocardiography and DTI at mitral annulus level. Patients with AS were divided into 2 groups: 16 patients who presented initial signs of HF and a depressed left ventricular systolic function (AS I) (EF: 35%-50%) and 19 patients were asymptomatic and had normal left ventricular systolic function (EF > 50%) (ASII). The 16 symptomatic AS patients underwent surgical aortic valve replacement and were examined after 1 year. RESULTS: DTI was able to detect abnormalities of systolic and diastolic function in AS: the significantly lower peak S velocity in AS I than in AS II and in controls, both at septum and lateral wall level; the significantly lower peak E velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significantly higher peak A velocity in AS I than in AS II and in controls both at septum and lateral wall level; the significant lower E/A ratio in AS I than in AS II and in controls both at septum and lateral wall level. CONCLUSION: We found a significant inverse correlation between DTI lateral S velocity, DTI peak E velocity, lateral DTI E/A ratio, and AS peak and mean gradient. According to the results of this study we can affirm that DTI parameters surely had an important physiopathological impact in the knowledge of myocardial function in patients with severe aortic stenosis.     

Contrast agent increases Doppler velocities and improves reproducibility of aortic valve area measurements in patients with aortic stenosis.

Observer variability may limit assessment of aortic stenosis by Doppler echocardiography. This study aimed to assess whether echocardiographic contrast agent improves reproducibility of aortic valve area (AVA) measurements for patients with aortic stenosis. In all, 20 patients with aortic stenosis (67 +/- 10 years old) underwent noncontrast and contrast Doppler echocardiography on 2 occasions, 3 weeks apart. Intraobserver and interobserver coefficients of reproducibility were 0.36 and 0.20 cm for left ventricular outflow tract (LVOT) diameter, and 0.38 and 0.24 cm(2) for AVA, respectively. Although intraobserver reproducibility was unaffected, contrast improved interobserver reproducibility for LVOT diameter (mean of differences -0.02 +/- 0.07 cm vs 0.01 +/- 0.10 cm, P <.05) and AVA (mean of differences 0.02 +/- 0.10 cm(2) vs 0.07 +/- 0.12 cm(2), P <.05). Prevalve and postvalve velocities were increased with contrast compared with noncontrast imaging (prevalve, 1.07 +/- 0.20 vs 0.94 +/- 0.19 m/s, P <.01; postvalve, 3.76 +/- 0.87 vs 3.47 +/- 0.78 m/s, P <.01). We conclude that contrast significantly increases Doppler velocities and produces modest improvements in reproducibility of LVOT diameter and AVA. We suggest that, when assessing patients with aortic stenosis, contrast agents should be considered in patients who are difficult to image with poor baseline LVOT images or Doppler studies, or where there is poor interobserver reproducibility.     

经导管主动脉瓣置换术后肺动脉压力的变化

目的应用超声心动图评估重度主动脉瓣狭窄患者经导管主动脉瓣置换(TAVI)术后肺动脉压力(PASP)的变化。方法入选94例重度主动脉瓣狭窄患者,均成功完成TAVI手术。根据术前PASP分为两组,无肺动脉高压组(PASP<40mmHg)和肺动脉高压组(PASP≥40mmHg)。结果TAVI术后,无肺动脉高压组和肺动脉高压组PASP均降低。肺动脉高压组具有更小的主动脉瓣面积[(0.58±0.16vs 0.67±0.16)cm^2,P=0.014],更高的主动脉瓣平均跨瓣压差[(60.8±17.3vs 53.9±17.2)mmHg,P=0.035],中度以上二尖瓣反流[(11.6vs 3.9)%,P<0.001]和中度以上三尖瓣反流[(13.9vs 1.9)%,P<0.001]发生率更高。结论TAVI术后1年,肺动脉压力明显降低。