Prognostic value of tissue-tracking mitral annular displacement by speckle-tracking echocardiography in asymptomatic aor
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ORIGINAL INVESTIGATION
Prognostic value of tissue‑tracking mitral annular displacement by speckle‑tracking echocardiography in asymptomatic aortic stenosis patients with preserved left ventricular ejection fraction Ikuko Teraguchi1 · Takeshi Hozumi1 · Hiroki Emori1 · Kazushi Takemoto1 · Suwako Fujita1 · Teruaki Wada1 · Manabu Kashiwagi1 · Yasutsugu Shiono1 · Kunihiro Shimamura1 · Akio Kuroi1 · Takashi Tanimoto1 · Takashi Kubo1 · Atsushi Tanaka1 · Takashi Akasaka1 Received: 26 May 2020 / Revised: 26 August 2020 / Accepted: 10 September 2020 © Japanese Society of Echocardiography 2020
Abstract Background Tissue-tracking mitral annular displacement (TMAD) by speckle-tracking echocardiography provides rapid and simple assessment of left ventricular (LV) longitudinal deformation. The purpose of this study was to evaluate the value of TMAD for the assessment of LV longitudinal deformation in patients with severe AS and preserved LV ejection fraction (LVEF). Methods We studied 44 patients with severe AS preserved and LVEF in whom TMAD was assessed. Using TMAD analysis software, the base-to-apex displacement of automatically defined mid-point of mitral annular line in four-chamber view was quickly assessed, and the percentage of its displacement to LV length at end-diastole (%TMAD) was calculated. We investigated the association between %TMAD and the cardiac events including appearance of symptom (dyspnea on exertion and hospitalization due to heart failure), decreased LVEF ( 4 mm) according to the presence of MAC [21]. Maximal MAC thickness measured from the anterior to the posterior edge at its greatest width is also used to assess MAC. Speckle tracking analysis was performed to assess GLS using semiautomatic algorithm with QLAB software (10.5, Philips). Three points (two mitral annular and apical points) were positioned in each three apical cross sections (long-axis view, apical four-chamber view, and two-chamber view) enabling the software to track the myocardium semi-automatically throughout the cardiac cycle. The region of interest was adjusted to cover the thickness of the myocardium. And, careful inspection of tracking and manual correction was performed. The algorithm provided longitudinal strain curve during entire cardiac cycle in each segment. GLS was calculated by averaging the peak negative strain value during systole of 17 segments.
Tissue mitral annular displacement (TMAD) by speckle‑tracking echocardiography Tissue mitral annular displacement was assessed in the apical four-chamber view by speckle tracking analysis with semiautomatic algorithm with QLAB software by a single certified and experienced cardiologist blinded to the other echocardiographic date. Initially, we placed three regions of interest (ROI) in each view for TMAD analysis. The septal and lateral aspects of the mitral annulus and the apex were selected in each apical four-chamber view (Fig. 1). Once we set the ROIs, the mid-point between the two annular ROIs was automatically pointed. Setting ROI was the only manual procedure we need i
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