title: Left ventricular strain in chronic ischemic mitral regurgitation in relation to mitral tethering pattern.
abstract: BACKGROUND
  The aim of this retrospective study was to explore whether different tethering patterns in chronic ischemic mitral regurgitation have different distributions of left ventricular (LV) systolic longitudinal, circumferential, and radial strain before and after mitral valve repair.
  
  
  METHODS
  Sixty-one patients with chronic ischemic mitral regurgitation who underwent mitral repair were divided on the basis of the preoperative anterior/posterior tethering angle ratio (cutoff value, 0.76). There were 29 patients with symmetric (group 1) and 32 with asymmetric (group 2) preoperative tethering patterns. Assessment of longitudinal peak systolic strain was performed offline by applying speckle-tracking imaging to the apical two-chamber, three-chamber, and four-chamber views of the left ventricle. Peak systolic radial and circumferential strain was obtained from short-axis views at the basal, middle, and apical levels. Twenty healthy subjects served as controls.
  
  
  RESULTS
  In group 1, baseline LV strain was impaired in all LV segments, with the worst values in the anterolateral, anterior, and inferolateral segments at the midventricular and basal levels. In contrast, asymmetric patients showed higher values in the inferior and inferoseptal walls and values closer to normal in the other segments. After surgery, all strain measurements showed significant improvements in all LV segments in group 2, whereas in Group 1, strain worsened in the inferoseptal, inferior, and anteroseptal walls and did not change in the other segments.
  
  
  CONCLUSIONS
  Patients with baseline symmetric tethering patterns showed more extensive abnormal strain, which was observed in all LV segments and was not reverted by surgery. These findings require confirmation in additional larger studies.
authors: Department of Heart and Vessels, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it
authors: Sandro
authors: S
authors: Gelsomino
authors: Leen
authors: L
authors: van Garsse
authors: Fabiana
authors: F
authors: Lucà
authors: Orlando
authors: O
authors: Parise
authors: Emile
authors: E
authors: Cheriex
authors: Carmelo Massimiliano
authors: CM
authors: Rao
authors: Gian Franco
authors: GF
authors: Gensini
authors: Jos
authors: J
authors: Maessen
mesh_terms: D000368:Aged; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications; D012189:Retrospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*