Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation
Background The assessment of left ventricular (LV) systolic function using conventional echocardiographic measures is problematic in the setting of mitral regurgitation (MR) given that altered loading conditions can mask underlying ventricular dysfunction. The purpose of this study was to characteri...
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| Veröffentlicht in: | Journal of the American Society of Echocardiography 2015-03, Vol.28 (3), p.284-293 |
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| creator | Arunamata, Alisa, MD Selamet Tierney, Elif Seda, MD Tacy, Theresa A., MD Punn, Rajesh, MD |
| description | Background The assessment of left ventricular (LV) systolic function using conventional echocardiographic measures is problematic in the setting of mitral regurgitation (MR) given that altered loading conditions can mask underlying ventricular dysfunction. The purpose of this study was to characterize LV function and deformation before and after effective mitral valve repair or replacement to determine echocardiographic measures associated with early postoperative myocardial dysfunction. Methods Baseline LV function was assessed retrospectively by conventional echocardiography and speckle-tracking strain analysis pre- and postoperatively in patients diagnosed with MR between January 2000 and March 2013, excluding patients with less than mild to moderate MR preoperatively, left-sided obstructive lesions, large septal defects, or more than mild MR postoperatively. Results Forty-six pediatric patients were evaluated (average age, 8.2 ± 6.4 years). Thirteen patients had normal preoperative ejection fractions but significant postoperative dysfunction (defined as an ejection fraction < 50%). Compared with the 33 patients with normal postoperative function, age (11.5 ± 7.1 vs 7.3 ± 5.7 years, P = .04), global circumferential strain (−13.2 ± 5.6% vs −17.1 ± 4.6%, P = .02), and global circumferential strain rate (−0.94 ± 0.40 vs −1.36 ± 0.42 sec−1 , P = .004) were found to be statistically different. Using receiver operating characteristic curves, an older preoperative age (area under the curve, 0.67; P = .03), lower global circumferential strain magnitude (area under the curve, 0.74; P = .007), and lower global circumferential strain rate magnitude (area under the curve, 0.80; P = .0004) were determined to be factors associated with early postoperative LV dysfunction after surgical repair of MR. Conclusions Strain measurements may be useful as part of the echocardiographic assessment of patients with MR and can guide timing for surgical repair in the pediatric population. |
| doi_str_mv | 10.1016/j.echo.2014.11.010 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1660654213</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0894731714008542</els_id><sourcerecordid>1660654213</sourcerecordid><originalsourceid>FETCH-LOGICAL-c411t-2aa5156d5bfbe7c3bb4806f610cb4fe22e4d8cfdca6fab0eb39fd3d886ab71c33</originalsourceid><addsrcrecordid>eNp9kkuP0zAUhS0EYsrAH2CBsmSTcG8eTiohpNFQHtJUVDyXluPctC5p3LGdkfIX-NXYysCCBd7Yss_5pHuOGXuOkCEgf3XMSB1MlgOWGWIGCA_YCmFdp7xeVw_ZCpp1mdYF1hfsiXNHAKgagMfsIq_iynHFfm0CQknbabO38nzQKtmSdJMll1w5Z5SWnrrkh_aHZCPtMCc743x432slh2Q7L-ZwfDu7fhqV12ZM9JjsKNx6G3g76TWN3i2QrfY2qL_L4Y6Sz7SPJC-j6yl71MvB0bP7_ZJ9e7f5ev0hvfn0_uP11U2qSkSf5lJWWPGuavuWalW0bdkA7zmCasue8pzKrlF9pyTvZQvUFuu-K7qm4bKtURXFJXu5cM_W3E7kvDhpp2gY5EhmcgI5B16VOUZpvkiVNc5Z6sXZ6pO0s0AQsQNxFLEDETsQiCJ0EEwv7vlTe6Lur-VP6EHwehFQmPJOkxVOhYRUSMyS8qIz-v_8N__Y1aDHWMdPmskdzWTHkJ9A4XIB4kv8BfETYAnQhLmK3xznsR4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1660654213</pqid></control><display><type>article</type><title>Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Arunamata, Alisa, MD ; Selamet Tierney, Elif Seda, MD ; Tacy, Theresa A., MD ; Punn, Rajesh, MD</creator><creatorcontrib>Arunamata, Alisa, MD ; Selamet Tierney, Elif Seda, MD ; Tacy, Theresa A., MD ; Punn, Rajesh, MD</creatorcontrib><description>Background The assessment of left ventricular (LV) systolic function using conventional echocardiographic measures is problematic in the setting of mitral regurgitation (MR) given that altered loading conditions can mask underlying ventricular dysfunction. The purpose of this study was to characterize LV function and deformation before and after effective mitral valve repair or replacement to determine echocardiographic measures associated with early postoperative myocardial dysfunction. Methods Baseline LV function was assessed retrospectively by conventional echocardiography and speckle-tracking strain analysis pre- and postoperatively in patients diagnosed with MR between January 2000 and March 2013, excluding patients with less than mild to moderate MR preoperatively, left-sided obstructive lesions, large septal defects, or more than mild MR postoperatively. Results Forty-six pediatric patients were evaluated (average age, 8.2 ± 6.4 years). Thirteen patients had normal preoperative ejection fractions but significant postoperative dysfunction (defined as an ejection fraction < 50%). Compared with the 33 patients with normal postoperative function, age (11.5 ± 7.1 vs 7.3 ± 5.7 years, P = .04), global circumferential strain (−13.2 ± 5.6% vs −17.1 ± 4.6%, P = .02), and global circumferential strain rate (−0.94 ± 0.40 vs −1.36 ± 0.42 sec−1 , P = .004) were found to be statistically different. Using receiver operating characteristic curves, an older preoperative age (area under the curve, 0.67; P = .03), lower global circumferential strain magnitude (area under the curve, 0.74; P = .007), and lower global circumferential strain rate magnitude (area under the curve, 0.80; P = .0004) were determined to be factors associated with early postoperative LV dysfunction after surgical repair of MR. Conclusions Strain measurements may be useful as part of the echocardiographic assessment of patients with MR and can guide timing for surgical repair in the pediatric population.</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2014.11.010</identifier><identifier>PMID: 25555521</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Cardiovascular ; Child ; Child, Preschool ; Echocardiography - methods ; Female ; Humans ; Image Interpretation, Computer-Assisted - methods ; Infant ; Male ; Mitral Valve Annuloplasty - adverse effects ; Mitral Valve Insufficiency - complications ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - surgery ; Mitral valve regurgitation ; Myocardial dysfunction ; Observer Variation ; Pediatric mitral valve surgery ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Speckle-tracking strain ; Stroke Volume ; Treatment Outcome ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - etiology ; Young Adult</subject><ispartof>Journal of the American Society of Echocardiography, 2015-03, Vol.28 (3), p.284-293</ispartof><rights>American Society of Echocardiography</rights><rights>2015 American Society of Echocardiography</rights><rights>Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-2aa5156d5bfbe7c3bb4806f610cb4fe22e4d8cfdca6fab0eb39fd3d886ab71c33</citedby><cites>FETCH-LOGICAL-c411t-2aa5156d5bfbe7c3bb4806f610cb4fe22e4d8cfdca6fab0eb39fd3d886ab71c33</cites><orcidid>0000-0001-9232-2231</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0894731714008542$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27903,27904,65309</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25555521$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arunamata, Alisa, MD</creatorcontrib><creatorcontrib>Selamet Tierney, Elif Seda, MD</creatorcontrib><creatorcontrib>Tacy, Theresa A., MD</creatorcontrib><creatorcontrib>Punn, Rajesh, MD</creatorcontrib><title>Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>Background The assessment of left ventricular (LV) systolic function using conventional echocardiographic measures is problematic in the setting of mitral regurgitation (MR) given that altered loading conditions can mask underlying ventricular dysfunction. The purpose of this study was to characterize LV function and deformation before and after effective mitral valve repair or replacement to determine echocardiographic measures associated with early postoperative myocardial dysfunction. Methods Baseline LV function was assessed retrospectively by conventional echocardiography and speckle-tracking strain analysis pre- and postoperatively in patients diagnosed with MR between January 2000 and March 2013, excluding patients with less than mild to moderate MR preoperatively, left-sided obstructive lesions, large septal defects, or more than mild MR postoperatively. Results Forty-six pediatric patients were evaluated (average age, 8.2 ± 6.4 years). Thirteen patients had normal preoperative ejection fractions but significant postoperative dysfunction (defined as an ejection fraction < 50%). Compared with the 33 patients with normal postoperative function, age (11.5 ± 7.1 vs 7.3 ± 5.7 years, P = .04), global circumferential strain (−13.2 ± 5.6% vs −17.1 ± 4.6%, P = .02), and global circumferential strain rate (−0.94 ± 0.40 vs −1.36 ± 0.42 sec−1 , P = .004) were found to be statistically different. Using receiver operating characteristic curves, an older preoperative age (area under the curve, 0.67; P = .03), lower global circumferential strain magnitude (area under the curve, 0.74; P = .007), and lower global circumferential strain rate magnitude (area under the curve, 0.80; P = .0004) were determined to be factors associated with early postoperative LV dysfunction after surgical repair of MR. Conclusions Strain measurements may be useful as part of the echocardiographic assessment of patients with MR and can guide timing for surgical repair in the pediatric population.</description><subject>Adolescent</subject><subject>Cardiovascular</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Infant</subject><subject>Male</subject><subject>Mitral Valve Annuloplasty - adverse effects</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Mitral Valve Insufficiency - diagnostic imaging</subject><subject>Mitral Valve Insufficiency - surgery</subject><subject>Mitral valve regurgitation</subject><subject>Myocardial dysfunction</subject><subject>Observer Variation</subject><subject>Pediatric mitral valve surgery</subject><subject>Reproducibility of Results</subject><subject>Retrospective Studies</subject><subject>Sensitivity and Specificity</subject><subject>Speckle-tracking strain</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - etiology</subject><subject>Young Adult</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kkuP0zAUhS0EYsrAH2CBsmSTcG8eTiohpNFQHtJUVDyXluPctC5p3LGdkfIX-NXYysCCBd7Yss_5pHuOGXuOkCEgf3XMSB1MlgOWGWIGCA_YCmFdp7xeVw_ZCpp1mdYF1hfsiXNHAKgagMfsIq_iynHFfm0CQknbabO38nzQKtmSdJMll1w5Z5SWnrrkh_aHZCPtMCc743x432slh2Q7L-ZwfDu7fhqV12ZM9JjsKNx6G3g76TWN3i2QrfY2qL_L4Y6Sz7SPJC-j6yl71MvB0bP7_ZJ9e7f5ev0hvfn0_uP11U2qSkSf5lJWWPGuavuWalW0bdkA7zmCasue8pzKrlF9pyTvZQvUFuu-K7qm4bKtURXFJXu5cM_W3E7kvDhpp2gY5EhmcgI5B16VOUZpvkiVNc5Z6sXZ6pO0s0AQsQNxFLEDETsQiCJ0EEwv7vlTe6Lur-VP6EHwehFQmPJOkxVOhYRUSMyS8qIz-v_8N__Y1aDHWMdPmskdzWTHkJ9A4XIB4kv8BfETYAnQhLmK3xznsR4</recordid><startdate>20150301</startdate><enddate>20150301</enddate><creator>Arunamata, Alisa, MD</creator><creator>Selamet Tierney, Elif Seda, MD</creator><creator>Tacy, Theresa A., MD</creator><creator>Punn, Rajesh, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9232-2231</orcidid></search><sort><creationdate>20150301</creationdate><title>Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation</title><author>Arunamata, Alisa, MD ; Selamet Tierney, Elif Seda, MD ; Tacy, Theresa A., MD ; Punn, Rajesh, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-2aa5156d5bfbe7c3bb4806f610cb4fe22e4d8cfdca6fab0eb39fd3d886ab71c33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adolescent</topic><topic>Cardiovascular</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Infant</topic><topic>Male</topic><topic>Mitral Valve Annuloplasty - adverse effects</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Mitral Valve Insufficiency - diagnostic imaging</topic><topic>Mitral Valve Insufficiency - surgery</topic><topic>Mitral valve regurgitation</topic><topic>Myocardial dysfunction</topic><topic>Observer Variation</topic><topic>Pediatric mitral valve surgery</topic><topic>Reproducibility of Results</topic><topic>Retrospective Studies</topic><topic>Sensitivity and Specificity</topic><topic>Speckle-tracking strain</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - etiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arunamata, Alisa, MD</creatorcontrib><creatorcontrib>Selamet Tierney, Elif Seda, MD</creatorcontrib><creatorcontrib>Tacy, Theresa A., MD</creatorcontrib><creatorcontrib>Punn, Rajesh, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arunamata, Alisa, MD</au><au>Selamet Tierney, Elif Seda, MD</au><au>Tacy, Theresa A., MD</au><au>Punn, Rajesh, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2015-03-01</date><risdate>2015</risdate><volume>28</volume><issue>3</issue><spage>284</spage><epage>293</epage><pages>284-293</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>Background The assessment of left ventricular (LV) systolic function using conventional echocardiographic measures is problematic in the setting of mitral regurgitation (MR) given that altered loading conditions can mask underlying ventricular dysfunction. The purpose of this study was to characterize LV function and deformation before and after effective mitral valve repair or replacement to determine echocardiographic measures associated with early postoperative myocardial dysfunction. Methods Baseline LV function was assessed retrospectively by conventional echocardiography and speckle-tracking strain analysis pre- and postoperatively in patients diagnosed with MR between January 2000 and March 2013, excluding patients with less than mild to moderate MR preoperatively, left-sided obstructive lesions, large septal defects, or more than mild MR postoperatively. Results Forty-six pediatric patients were evaluated (average age, 8.2 ± 6.4 years). Thirteen patients had normal preoperative ejection fractions but significant postoperative dysfunction (defined as an ejection fraction < 50%). Compared with the 33 patients with normal postoperative function, age (11.5 ± 7.1 vs 7.3 ± 5.7 years, P = .04), global circumferential strain (−13.2 ± 5.6% vs −17.1 ± 4.6%, P = .02), and global circumferential strain rate (−0.94 ± 0.40 vs −1.36 ± 0.42 sec−1 , P = .004) were found to be statistically different. Using receiver operating characteristic curves, an older preoperative age (area under the curve, 0.67; P = .03), lower global circumferential strain magnitude (area under the curve, 0.74; P = .007), and lower global circumferential strain rate magnitude (area under the curve, 0.80; P = .0004) were determined to be factors associated with early postoperative LV dysfunction after surgical repair of MR. Conclusions Strain measurements may be useful as part of the echocardiographic assessment of patients with MR and can guide timing for surgical repair in the pediatric population.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>25555521</pmid><doi>10.1016/j.echo.2014.11.010</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-9232-2231</orcidid></addata></record> |
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| subjects | Adolescent Cardiovascular Child Child, Preschool Echocardiography - methods Female Humans Image Interpretation, Computer-Assisted - methods Infant Male Mitral Valve Annuloplasty - adverse effects Mitral Valve Insufficiency - complications Mitral Valve Insufficiency - diagnostic imaging Mitral Valve Insufficiency - surgery Mitral valve regurgitation Myocardial dysfunction Observer Variation Pediatric mitral valve surgery Reproducibility of Results Retrospective Studies Sensitivity and Specificity Speckle-tracking strain Stroke Volume Treatment Outcome Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - etiology Young Adult |
| title | Echocardiographic Measures Associated With Early Postsurgical Myocardial Dysfunction in Pediatric Patients With Mitral Valve Regurgitation |
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