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Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation

Antonino Di Franco; Jiwon Kim; Sara Rodriguez-Diego; Omar Khalique; Jonathan Y. Siden; Samantha R. Goldburg; Neil K. Mehta; Aparna Srinivasan; Mark B. Ratcliffe; Robert A. Levine; Filippo Crea; Richard B. Devereux; Jonathan Weinsaft

Title:
Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation
Author(s):
Di Franco, Antonino
Kim, Jiwon
Rodriguez-Diego, Sara
Khalique, Omar
Siden, Jonathan Y.
Goldburg, Samantha R.
Mehta, Neil K.
Srinivasan, Aparna
Ratcliffe, Mark B.
Levine, Robert A.
Crea, Filippo
Devereux, Richard B.
Weinsaft, Jonathan
Date:
Type:
Articles
Department(s):
Medicine
Volume:
12
Persistent URL:
Book/Journal Title:
PLoS ONE
Abstract:
Background: Ischemic mitral regurgitation (iMR) predisposes to right ventricular (RV) pressure and volume overload, providing a nidus for RV dysfunction (RVDYS) and non-ischemic fibrosis (NIF). Echocardiography (echo) is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown. Methods: iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR) within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S’, fractional area change [FAC]), and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS]) and parasternal long axis orientation (transverse strain). CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI) and septal NIF. Results: 73 iMR patients were studied; 36% had RVDYS (EF<50%) on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05). CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73) and lowest for RV-S’ (r = 0.43; all p<0.001). RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001). Whereas all RV indices were lower among NIF-affected patients (all p≤0.006), percent change was largest for transverse strain (48.3%). CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001) and transverse strain (r = 0.38, p = 0.002) (R = 0.78, p<0.001). Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87–0.99]|0.91[0.84–0.99], both p<0.001), and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively). Conclusion: Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR.
Subject(s):
Heart--Right ventricle
Cardiology
Medicine
Echocardiography
Publisher DOI:
https://doi.org/10.1371/journal.pone.0185657
Item views
19
Metadata:
text | xml
Suggested Citation:
Antonino Di Franco, Jiwon Kim, Sara Rodriguez-Diego, Omar Khalique, Jonathan Y. Siden, Samantha R. Goldburg, Neil K. Mehta, Aparna Srinivasan, Mark B. Ratcliffe, Robert A. Levine, Filippo Crea, Richard B. Devereux, Jonathan Weinsaft, , Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation, Columbia University Academic Commons, .

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