title: Alterations in transmural myocardial strain: an early marker of left ventricular dysfunction in mitral regurgitation?
abstract: BACKGROUND
  In asymptomatic patients with severe isolated mitral regurgitation (MR), identifying the onset of early left ventricular (LV) dysfunction can guide the timing of surgical intervention. We hypothesized that changes in LV transmural myocardial strain represent an early marker of LV dysfunction in an ovine chronic MR model.
  
  
  RESULTS
  Sheep were randomized to control (CTRL, n=8) or experimental (EXP, n=12) groups. In EXP, a 3.5- or 4.8-mm hole was created in the posterior mitral leaflet to generate "pure" MR. Transmural beadsets were inserted into the lateral and anterior LV wall to radiographically measure 3-dimensional transmural strains during systole and diastolic filling, at 1 and 12 weeks postoperatively. MR grade was higher in EXP than CTRL at 1 and 12 weeks (3.0 [2-4] versus 0.5 [0-2]; 3.0 [1-4] versus 0.5 [0-1], respectively, both P<0.001). At 12 weeks, LV mass index was greater in EXP than CTRL (201+/-18 versus 173+/-17 g/m(2); P<0.01). LVEDVI increased in EXP from 1 to 12 weeks (P=0.015). Between the 1 and 12 week values, the change in BNP (-4.5+/-4.4 versus -3.0+/-3.6 pmol/L), PRSW (9+/-13 versus 23+/-18 mm Hg), tau (-3+/-11 versus -4+/-7 ms), and systolic strains was similar between EXP and CTRL. The changes in longitudinal diastolic filling strains between 1 and 12 weeks, however, were greater in EXP versus CTRL in the subendocardium (lateral: -0.08+/-0.05 versus 0.02+/-0.14; anterior: -0.10+/-0.05 versus -0.02+/-0.07, both P<0.01).
  
  
  CONCLUSIONS
  Twelve weeks of ovine "pure" MR caused LV remodeling with early changes in LV function detected by alterations in transmural myocardial strain, but not by changes in BNP, PRSW, or tau.
authors.affiliation: Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247, USA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Carlhäll
authors.forename: Tom C
authors.initials: TC
authors.lastname: Nguyen
authors.forename: Akinobu
authors.initials: A
authors.lastname: Itoh
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Ennis
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bothe
authors.forename: David
authors.initials: D
authors.lastname: Liang
authors.forename: Neil B
authors.initials: NB
authors.lastname: Ingels
authors.forename: D Craig
authors.initials: DC
authors.lastname: Miller
mesh_terms: D000818:Animals; D003326:Coronary Circulation; D003971:Diastole; D006321:Heart / Q000503:physiopathology*; D006439:Hemodynamics; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D012756:Sheep; D013314:Stress, Mechanical; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D020257:Ventricular Remodeling
chemical_list: D020097:Natriuretic Peptide, Brain