The role of left ventricular long axis contraction in patients with asymptomatic non-ischemic mitral valve regurgitation and normal systolic function.
BACKGROUND
Several indices have been proposed in order to better evaluate chronic mitral regurgitation, however, none of them is unique, thus underlying the diagnostic deficiency. We aimed to investigate the role of long axis contraction in both ventricles in patients with non-ischemic asymptomatic mitral regurgitation (MR).


METHODS
Eighty-nine patients (40 men, mean age 59.9+/-13.5 years) with non-ischemic asymptomatic MR along with 50 healthy controls were studied. An echocardiographic, including tissue Doppler imaging study, an exercise radionuclide cineangiography and a cardiac catheterization were also performed.


RESULTS
Fifty of 89 patients (56.2%) had a normal response of left ventricular (LV) ejection fraction on exercise. LV end-diastolic diameter and volume index were significantly higher in patients with an impaired LV response. Moreover, systolic wave maximal velocity and systolic wave slope both at the lateral wall and at the inter-ventricular septum were significantly lower in patients with an impaired LV response. Systolic wave maximal velocity at the lateral wall was the index that best predicted LV response to exercise; while a cutoff value of 9.5 cm/s predicted an impaired LV response with a sensitivity of 96% and a specificity of 100%. MR as defined by the width of vena contracta, was mild/moderate in 78% of patients with a systolic wave maximal velocity at the lateral wall >9.5 cm/s and severe in 69.2% of patients with a velocity <9.5 cm/s.


CONCLUSIONS
In patients with asymptomatic non-ischemic MR, the evaluation of LV long axis contraction at rest can unmask a subnormal LV functional status.
Paraskevaidis
Ioannis A
IA
Second Department of Cardiology, Athens University Medical School, Attiko University Hospital, Greece. elbee@ath.forthnet.gr
Kyrzopoulos
Stamatis
S
Tsiapras
Dimitrios
D
Iliodromitis
Efstathios K
EK
Parissis
John
J
Farmakis
Dimitrios
D
Kremastinos
Dimitrios T
DT
D006328:Cardiac Catheterization; D016022:Case-Control Studies; D002932:Cineangiography; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009200:Myocardial Contraction / Q000502:physiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*