title: Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation.
abstract: OBJECTIVE
  Left ventricular (LV) shape and LV dyssynchrony are two cofactors associated with functional mitral regurgitation (MR) in patients with heart failure. Both can be accurately examined by real-time three-dimensional echocardiography (3DE). We examined the relationship between dynamic MR and exercise-induced changes in LV shape and synchronicity using 3DE.
  
  
  RESULTS
  Fifty patients with systolic LV dysfunction underwent 2D and 3D quantitative assessment of LV function, shape, and synchronicity at rest and during symptom-limited exercise test. According to the magnitude of change in MR, patients were divided into EMR group (15 patients, 30%), if the degree of MR increased during test, and NEMR group. During exercise, the changes in LV volumes and ejection fraction were similar in both groups, whereas changes in mitral valvular deformation parameters, in LV sphericity index, and in the extent of LV dyssynchrony were more pronounced in the EMR group. At rest, only the 3D sphericity index could distinguish the two groups. By stepwise multiple regression model, dynamic changes in the systolic dyssynchrony index, sphericity index, and coaptation distance were associated with dynamic MR (r(2) = 0.45, P = 0.012).
  
  
  CONCLUSIONS
  Dynamic MR during exercise is related to the 3D changes in LV shape and in LV synchronicity.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan. m2izumo@marianna-u.ac.jp
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.forename: Patrizio
authors.initials: P
authors.lastname: Lancellotti
authors.forename: Kengo
authors.initials: K
authors.lastname: Suzuki
authors.forename: Seisyou
authors.initials: S
authors.lastname: Kou
authors.forename: Takashi
authors.initials: T
authors.lastname: Shimozato
authors.forename: Akio
authors.initials: A
authors.lastname: Hayashi
authors.forename: Yoshihiro J
authors.initials: YJ
authors.lastname: Akashi
authors.forename: Naohiko
authors.initials: N
authors.lastname: Osada
authors.forename: Kazuto
authors.initials: K
authors.lastname: Omiya
authors.forename: Sachihiko
authors.initials: S
authors.lastname: Nobuoka
authors.forename: Eiji
authors.initials: E
authors.lastname: Ohtaki
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miyake
mesh_terms: D000368:Aged; D019560:Echocardiography, Three-Dimensional; D005080:Exercise Test; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*