494 Atrial strain 2d by velocity vector imaging, a novel method for the evaluation of clinical improvement post cardiac resynchronization
Eur J Echocardiography Abstracts Supplement, December 2006
LA mechanical function and LV systolic/diastolic parameters change
in patients treated with ablation procedure for atrial fibrillation with no
or minimal structural heart disease. A prospective 7 mont
A. Drzewiecka -Gerber 1 ; A.M. Wnuk-Wojnar 2 ; I. Wozniak-Skowerska 2 ;
J. Krauze 2 ; A. Rybicka-Musialik 2 ; S. Nowak 2 ; C. Czerwinski 2 ; M. Trusz-Gluza 2
1Katowice, Poland; 2I Klinika Kardiologii, SPSK nr 7, Ziolowa 47, Katowice,
Background: Hemodynamics of isolated atrial fibrillation (AF) is belived to
be associated with slight enlargement of left atrial (LA) size and minor de-
gree of left ventricular (LV) diastolic dysfunction, that is presumed rather to
be a result than a cause of so called „lone AF”. Positive impact of sinus
rhythm restoration by catheter ablation on LA size and LV function remains
Methods and results: A group of 29 consecutive patients with no or mini-
mal structural heart disease (mean LVEF 64±5%) treated with catheter abla-
tion according to Pappone technique were included into prospective follow-
Mean age was 47±11 yrs, 17 patients had paroxysmal and 12 persistent AF.
11 patients (37%) had mild structural disease (7 hypertension, 4 coronary artery
disease). TTE was performed at baseline and after mean time of 208±73 days
Conventional parameters, such as: LVEF, left atrium end systolic area(LAs
area), left atrium emptying fraction (LAEF%), left atrium filling fraction
(LAFF); E/A mitral flow ratio; as well as „new” diastolic/systolic indexes
such as tissue Doppler imaging peak velocity of mitral annulus motion
(TDI), Tei index, tissue tracking of anterior and posterior mitral leaflet,
color M-mode propagation velocity were derived at baseline and follow-
20 patients (68%) demonstrated no arrhythmia recurrences at follow-up
(AF negative group), whereas 9 patients (32%) had AF episodes con-
firmed in ECG Holter monitoring. Echo baseline parameters did not differ
between the groups.
At follow-up examination, however, a significant LVEF improvement was
observed in AF negative group versus AF positive group (68±5 versus
65±5; p=0.02); as well as significant growth in TDI peak velocity in AF
negative versus AF positive group (12±2 versus 9±1 cm/s, respectively,
p=0.01). Analyzing AF positive and negative group, a significant positive
trend in LVEF improvement in AF negative group was observed at follow-
up comparing to baseline (68±5% versus 65±5%, respectively, p=0.06).
LAEF improved significantly in AF negative group at follow-up comparing
to baseline (64±14% versus 59±10%, respectively, p=0.003) as did TDI
early peak velocity (12±2 cm/s versus 10±1 cm/s, respectively, p=0.002).
Propagation velocity also increased in AF negative patients (54±11 cm/s
versus 46±10 cm/s, respectively, p=0.008).
Conclusions: This study demonstrates , that successful restoration of sinus
rhythm in patients with lone AF treated with ablation procedure results in
significant improvement of LA and LV functional parameters, that can be
easily measured by echocardiography.
The mechanism of mitral regurgitation complicated by non-valvular
atrial fibrillation investigated using a two-dimensional tissue tracking
Y. Nakamura 1 ; A. Mori 1 ; H. Saeki 1 ; T. Matsunaka 1 ; H. Habara 1 ; M. Suzuki 1 ;
O. Mori 2 ; Y. Kazatani 1
1Ehime Prefectural Central Hospital, Cardiology Dept., Matsuyama, Japan;
2Hitachi Medical Co, Tokyo, Japan
Background: Mitral regurgitation associated with non-valvular atrial fi-
brillation usually presents without left ventricular (LV) dysfunction. Here
we discusses the mechanism of mitral regurgitation despite normal LV
function in NVAF patients. Two-dimensional tissue tracking is a new tech-
nology functioning independently of ultrasound beam angulation, which
analyses image texture. We hypothesized that left atrial (LA) dysfunc-
tion resulted in mitral regurgitation because diseased LA could not vend
up the posterior mitral ring and tested this using a 2D tissue tracking
Methods and results: Twenty-two NVAF patients without organic mitral dis-
ease and with normal LV function were evaluated. Atrial strain, cyclic varia-
tions of mitral ring angulations (α , ß) and PML angulation (γ). Controls (n=21)
were sinus node rhythms without a history of paroxysmal atrial fibrillation.
The value of angulation ß of NVAF group (90±12 degree) was greater than
control (79±20 degree) (p=0.218). The strain value of NVAF was lower
(33±15% vs 51±17%, p=0.0004), and the diameter of mitral ring was larger
compared to the control (40±5 mm vs 33±4 mm, p<0.0001). Positive corre-
lations between mitral regurgitation and angulation α, and inverse correla-
tions with angulation were found. LA strain also correlated inversely with b, g
and mitral ring diameter.
Conclusions: In patients with NVAF, mitral regurgitation results from vend
up the mitral ring and restricted mitral ring motion because of LA dys-
Atrial strain 2d by velocity vector imaging, a novel method for the
evaluation of clinical improvement post cardiac resynchronization
A.R. Martiniello 1 ; P. Caso 1 ; C. Cioppa 1 ; S. Padula 1 ; M.V. Betancourt C 1 ;
I. Caso 1 ; G. Tonti 2 ; R. Calabro’ 1
1Monaldi Hospital, Cardiology Dept., Naples, Italy; 2S.S. Annunziata Hospital,
Cardiology Dept., Sulmona, Italy
Background: Cardiac resynchronization therapy (CRT) induces left ventricu-
lar remodelling reversal (LVR) in patients (pts) with congestive heart failure
(CHF). However, the prediction of benefit on diastolic performance is con-
troversial. The left atrial (LA) reservoir plays an important role in left ventricu-
lar (LV) filling. Velocity Vector Imaging-Siemens (VVI) is a novel 2D grayscale
image angle indipendent analysis to assess atrial function that may elimi-
nate the inherent limitations of Doppler Tissue Imaging (DTI).
Aim of this study: To assess the value of regional compliance of the LA wall
to predict improvement of NYHA class in ischemic (ISCH) pts post CRT.
Methods: VVI of the LA in the apical 4C (A4C) view was done in 14 ISCH pts
with LBBB (67±10 ys, 23±6 EF %, 12 male). By tracing a region of interest
that encompassed the LA myocardium, atrial peak strain reservoir function
(SMR) with 2D strain was calculated during LV systole. For regional analy-
sis, three segments (interatrial midwall septal, roof atrium, midwall lateral)
were measured. All segments were analysable using off-line VVI worksta-
tion. Standard Doppler-derived parameters of the diastolic function: E/A mi-
tral flow ratio (EA), deceleration time E mitral flow (DT) were calculated; E
mitral flow/E mitral lateral annulus ratio (E/Em), E mitral flow/E septal annu-
lus ratio (E/Es) were measured using DTI.
Results: SMR of interatrial midwall septal predicted improvement of NYHA
class at 3-6 months f.u. The overall rate responders at 3 month f.u.was 7/14:
6.7±3.8 vs 2.2±2 SMR (%), p<0.05. The overall rate responders at 6 month
f.u.was 7/13 pts: 6.7±3.8 vs 1.7±2 SMR (%), p<0.05. SMR of interatrial
midwall septal showed significant correlation with E/A (r -50, p<0.05) and
DT (r 0.67, p 0.004) of mitral inflow pattern pre CRT.
Conclusions: Regional assessment of LA function was easily calculated
using 2D grayscale image. SMR of interatrial midwall septal predicts, in ISCH
pts, improvement of NYHA class post CRT.
Left atrial remodeling in patients undergoing mitral valve repair for
mitral regurgitation: size or shape?
F. Antonini-Canterin 1 ; C.C. Beladan 2 ; B.A. Popescu 2 ; C. Ginghina 2 ;
A.C. Popescu 3 ; R. Piazza 1 ; B. Zingone 4 ; G.L. Nicolosi 1
1ARC, Ospedale Civile, Cardiology Dept., Pordenone, Italy; 2Institute Of
Cardiovascular Diseases, Cardiology Dept., Bucharest, Romania; 3Elias
Hospital, Cardiology Dept., Bucharest, Romania; 4Ospedali Riuniti,
Cardiosurgery Dept., Trieste, Italy
Background: Left ventricular (LV) remodeling in patients (pts) undergoing
mitral valve repair (MVR) for severe mitral regurgitation (MR) has been evalu-
ated in several studies. Few studies, however, emphasized left atrial (LA)
size as a predictor of outcome in pts with chronic MR and none of them
specifically adressed the changes in LA geometry after surgery. We sought
to assess LA remodeling (in terms of size and shape) in patients undergoing
MVR for symptomatic, isolated MR.
Methods: The study group consisted of 54 pts (aged 63±11 years, 36 men)
who underwent MVR for symptomatic, isolated MR and who had echocardio-
graphic assessment before and within one year after surgery (3±2 months).
LA superior-inferior, medial-lateral, antero-posterior diameters, area, volume,
and LA sphericity index (the ratio between medial-lateral and superior-infe-
rior diameters) as well as LV parameters of systolic and diastolic function
were assessed off-line by a single, blinded investigator. Seven pts (13%)
had concomitant coronary artery bypass surgery (CABG) at the time of MVR.
Results: We found a significant decrease in all LA diameters after MVR (49±7
vs 56±8 mm for medial-lateral, 56±7 vs 66±10 mm for superior-inferior, 43±8
vs 49±9 mm for antero-posterior), area (26±7 vs 34±10 cm2), volume (95±42
by guest on January 5, 2012