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Back to 2014 Annual Meeting Abstracts


Mechanism of Left Ventricular Hyperkinetic Motion in Patients with Mitral Regurgitation: A Study Using Two-dimensional Speckle Tracking Analysis
Kazato Ito1, Yukio Abe2, Chiharu Tanaka2, Atsuko Furukawa2, Kentaro Yano1, Daisuke Tonomura1, Kosuke Takehara1, Naoto Kino1, Keiichi Furubayashi1, Yoshihisa Shimada1, Toshiya Kurotobi1, Takao Tsuchida1, Hitoshi Fukumoto1, Minoru Yoshiyama3, Junichi Yoshikawa4, Takahiko Naruko2, Toshihiko Shibata2.
1Shiroyama Hospital, Habikino, Japan, 2Osaka City General Hospital, Osaka, Japan, 3Osaka City University Medical School, Osaka, Japan, 4Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan.

BACKGROUND: Mitral regurgitation (MR) is a valvular disease characterized by compensative volume overload and left ventricular (LV) hyperkinetic motion. However, the details of LV hyperkinetic motion in MR patients are still unknown. The purpose of this study was to investigate the mechanism of LV hyperkinetic motion in patients with MR using speckle tracking analysis in two-dimensional echocardiography.
METHODS: Twelve patients with severe primary MR and LV ejection fraction above 60% underwent echocardiography. Patients with coronary artery disease, cardiomyopathy, or atrial fibrillation were excluded. Global LV radial strain, global LV endocardial longitudinal strain, global LV epicardial longitudinal strain, LV sphericity index at end-diastole, and LV sphericity index at end-systole were derived from two-dimensional speckle tracking analysis in the four-chamber view. The results were compared with those in 12 healthy controls.
RESULTS: There was no significant difference in LV ejection fraction between MR patients and controls (70±7% vs. 66±6%). However, LV end-diastolic volume and LV total stroke volume were significantly larger in MR patients than in controls (121±31 ml vs. 79±22 ml, P=0.0008; and 85±26 ml vs. 51±13 ml, P=0.0006, respectively). There was no significant difference in global LV endocardial longitudinal strain or epicardial longitudinal strain between MR patients and controls (-20±5% vs. -21±5%; and -9±3% vs. -11±3%, respectively). In contrast, global LV radial strain was significantly lager in MR patients than in controls (37±12% vs. 25±9%, P=0.0096). LV sphericity index decreased from 0.71±0.13 at end-diastole to 0.58±0.12 at end-systole in MR patients, and the change was significantly larger in MR patients than in controls (-0.13±0.08 vs. -0.05±0.07, P=0.016).
CONCLUSIONS: LV hyperkinetic motion in patients with severe MR does not depend on the increase in LV myocardial shortening in a longitudinal direction, but depends on the increase in LV myocardial thickening and inward motion in a transverse direction.


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