Evaluation of right and left ventricular function in patients with ischemic heart disease complicated by mitral insufficiency
https://doi.org/10.18087/cardio.2022.1.n1695
Abstract
Aim To evaluate the right and left ventricular function and their interaction in patients with ischemic heart disease (IHD) complicated with mitral valve insufficiency (MVI) according to data of echocardiography (EchoCG) with the strain in gray scale, vector and diagram analyses.
Material and methods The study included 118 patients evaluated with EchoCG at the preoperative stage of treatment; 71 of these patients had ischemic MVI (group 1) and 47 patients had uncomplicated IHD (group 2 or comparison group). Mean age of patients was 64±10 years. All patients underwent a surgery in an appropriate volume for myocardial revascularization supplemented with mitral valve plasty or replacement in patients with MVI. Standard EchoCG parameters and data obtained by postprocessing the EchoCG gray-scale images using the strain in gray scale, vector and diagram analyses were evaluated.
Results In patients with complicated IHD, both global and local left ventricular (LV) systolic function and the right ventricular (RV) fractional area change (FAC) were significantly decreased. At the same time, there were no significant differences in the tricuspid annular plane systolic excursion (TAPSE) measured in M-mode and in the tricuspid annular systolic wave velocity (VSta), which also characterize the RV systolic function. The global longitudinal strain, the velocities of LV volume change and RV area change, and the long axis change velocity were informative for the right and left chambers, whereas the velocities of LV volume and RV area changes better detected RV disorders. The Pearson’s correlation analysis used to identify the most significant parameters of interventricular interaction showed the presence of a strong inverse correlation, in the group of MVI patients, between the RV FAC and the degree of LV diastolic dysfunction (Е / e’) – r= –0,62; p=0.000, as well аs the degree of MVI (vena contracta) – r= –0.58; p=0.001. In the comparison group of IHD patients without MVI, the correlation of RV FAC with E / e’ was absent (r=0.28; p=0.192). The volume change velocity (dVol / dt) moderately correlated with the RV end-systolic and end-diastolic area in IHD patients but not in IHD patients with MVI. The RV area change velocity (dS / dt) evaluated during systole and diastole moderately significantly correlated with the LV end-diastolic volume.
Conclusion Additional overload of left heart chambers in ischemic MVI is a factor that influences the development of the systemic and pulmonary circuit disorders. Recording and evaluation of global longitudinal strain, LV volume change velocity, and long axis change velocity with simultaneous recording of the segmental myocardial displacement velocity serve as highly informative criteria for disorders of LV and RV function. The vector analysis allows quantitative estimation of the local segmental myocardial function. Decreased velocities of the free RV wall segmental displacements during systole and diastole are characteristic of systolic and diastolic dysfunction in patients with IHD complicated with mitral regurgitation.
Supporting agencies: Funding The study was performed a part of the State Assignment of the Academician B.V. Petrovsky National Research Centre of Surgery # 0394‑2020‑0007 “Creation of the Informational Platform for Support of Decision-Making in Diagnostics and Treatment of Patients with Pathologies of the Cardiovascular System and Oncology”. No conflict of interest is reported.
About the Authors
T. Yu. Kulagina
Scientific Institution “Petrovsky national research centre of surgery”, Moscow
Russian Federation
Russian Federation
PhD, MD, Head of the Laboratory of Electrophysiology and Stress Tests
V. A. Sandrikov
Scientific Institution “Petrovsky national research centre of surgery”, Moscow
Russian Federation
Russian Federation
academician of the Russian Academy of Sciences, PhD, MD, Prof., Head of department of Clinical Physiology, Instrumental and Radiation Diagnostics
E. Yu. Van
Scientific Institution “Petrovsky national research centre of surgery”, Moscow
Russian Federation
Russian Federation
Ph. D., Doctor of Ultrasound Diagnostics, Laboratory of Stress Tests and Electrophysiology, Department of Clinical Physiology, Instrumental and Radiation Diagnostics
R. Z. Zyabirova
Scientific Institution “Petrovsky national research centre of surgery”, Moscow
Russian Federation
Russian Federation
doctor of Functional Diagnostics of the Laboratory of Electrophysiology and Stress Tests of the Department of Clinical Physiology, Instrumental and Radiation Diagnostics
Yu. N. Petrova
Scientific Institution “Petrovsky national research centre of surgery”, Moscow
Russian Federation
Russian Federation
junior Researcher of the Laboratory of Electrophysiology and Stress Tests of the Department of Clinical Physiology, Instrumental and Radiation Diagnostics
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For citations:
Kulagina T.Yu., Sandrikov V.A., Van E.Yu., Zyabirova R.Z., Petrova Yu.N. Evaluation of right and left ventricular function in patients with ischemic heart disease complicated by mitral insufficiency. Kardiologiia. 2022;62(1):46-56. https://doi.org/10.18087/cardio.2022.1.n1695
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