Abnormal ventricular contractile pattern associated with late systolic mitral prolapse: a two-dimensional speckle tracki

  • PDF / 1,374,301 Bytes
  • 10 Pages / 595.276 x 790.866 pts Page_size
  • 68 Downloads / 137 Views

DOWNLOAD

REPORT


ORIGINAL PAPER

Abnormal ventricular contractile pattern associated with late systolic mitral prolapse: a two‑dimensional speckle tracking study Mario Castillo‑Sang1   · Cassady Palmer2 · Vien T. Truong2,3 · Michael Young2 · Sarah Wolking2 · Tarek Alsaied4 · Daniel Drake5 · Wojciech Mazur2 Received: 5 April 2020 / Accepted: 30 June 2020 © Springer Nature B.V. 2020

Abstract We sought to study the mechanics of ventricular contraction in patients with and outward basal movement. Using echocardiographic parasternal long-axis views we retrospectively screened 760 echocardiograms to enroll 50 individuals with late systolic bileaflet prolapse, papillary muscle traction, and outward movement of the sub-annular base and posterior mitral annulus in late systole. Two-dimensional speckle tracking echocardiography was used to analyze the mechanics of contraction. Global and regional longitudinal strain values between the study group and 45 healthy control subjects were compared. The study group’s global strain was lower compared to the control group. We identified a pattern of weak contraction of the inferior and lateral walls in the late systolic bileaflet prolapse group. The weakest segment in the study group was the basal-inferolateral segment (− 15.8% vs. − 21.5%, p  2 mm above the mitral annulus in a parasternal long-axis view. Barlow’s mitral valve was defined as severe redundant leaflet tissue with bileaflet prolapse. Mitral annular disjunction (MAD) was assessed using two-dimensional linear measurements in the parasternal long-axis view [10, 11]. We compared subjects with the abnormal contractility pattern and mitral annular disjunction (MAD) to those without MAD. The abnormal outward movement of the sub-annular base and posterior mitral annulus in late systole was identified on 2D PLAX echocardiography (Video 1, Video 2).

tracking. Frame rates for all studies were 50 Hz or higher. Fully automated strain software was used to detected endocardial contours throughout one complete R–R interval (AutoStrain, Tom Tec Imaging Systems, Unterschleissheim, Germany), and manually adjusted if the software failed to appropriately detect endocardial contours. The peak systolic strain was obtained for each segment and averaged for all 16 as a representation of GLS (Fig. 2). We compared GLS and RLS values between the study and control groups. To normalize the strain values between the groups we created a ratio of basal strain to the corresponding mid or apical strain. These strain ratios were compared between the two groups.

Speckle tracking echocardiographic assessment

Statistics

Global longitudinal strain (GLS) and regional longitudinal strain (RLS) values were obtained using dedicated twodimensional speckle tracking echocardiography (2D STE) software (Tom Tec Imaging Systems, Unterschleissheim, Germany). Non-foreshortened apical four, apical two chamber views, along with apical long axis views were used for analysis of longitudinal strain. Image quality for all studies were at least adequate, as this necessities for accurate

C