ABSTRACT Purpose: To study the significance of impaired positive peak rate of left ventricular (LV) pressure development (MR + dp/dt) and global systolic strain (GLPSS) values in patients presented with significant mitral incompetence (MR) in coronary artery disease (CAD) and early dilated cardiomyopathy (DCM) with normal ejection fraction (EF). Methods: A description of LV contractile behavior requires measurement of the ability of the ventricle to develop force (pressure) and to shorten. Hence, performance of the ventricle as a pump assessed in the present study by measuring the pressure developed by the ventricle (Left ventricular +dP/dt is estimated from MR jet as the rate of pressure rise from 1 to 3 m/sec) and shortening assessed by GLPSS (this Doppler technology allowed measurement of LV systolic strain for the entire length of LV myocardium). GLPSS and MR + dp/dt were calculated in 30 consecutive patients (mean age was 55 ± 12 years) characterized by echocardiographic evidence of moderate or severe MR (in CAD and DCM patients) and normal EF (mean LV Ejection Fraction of 50.9% ± 5.9%) and compared with those obtained in 35 consecutive controls (age 54.7 ± 11.4 years) with normal echocardiographic study of the heart. Results: The mean values of MR +dp/dt and GLPSS averaged from the 3 apical views, differed significantly in DCM and CAD patients (characterized by significant MR with normal EF) compared with control group, (MR + dp/dt = 733 ± 170 mmhg/s and GLPSS –13% ± 1.3%) versus (1420 ± 210 mmhg/s and -19.5% ± 3.3%) for patients versus control, respectively, p < 0.001. A depressed values of MR + dp/dt were highly correlated with GLPSS values in patients with CAD and DCM, r = 0.78. The combined use of 2D Strain (<-13%) and MR dp/dt (<900 mmhg/s) in the presence of MR (grade II or more) had 89% sensitivity and 92% specificity for detection of patients at risk of post-operative major cardiac events after MR and coronary artery bypass surgery. Conclusions: Latent LV systolic dysfunction could be defined noninvasively by depressed peak MR + dp/dt and GLPSS in the echocardiography laboratories.
Cite this paper
nullG. Elkilany, M. Groef and I. Kabbash, "How to Identify Latent Systolic Dysfunction and Post Operative Risk in Patients with Mitral Incompetence and Normal Ejection Fraction?," World Journal of Cardiovascular Surgery, Vol. 1 No. 2, 2011, pp. 11-17. doi: 10.4236/wjcs.2011.12003.
 M. K. Karunanithi and M. P. Feneley, “Single-Beat Determination of Preload Recruitable Stroke Work Relationship: Derivation and Evaluation in Conscious Dogs,” Journal of the American College of Cardiology, Vol. 35, 2000, pp. 502-513.
 B. A. Carabello, “Evolution of the Study of Left Ventricular Function: Everything Old Is New Again,” Circulation, Vol. 105, 2002, pp. 2701-2703.
 N. H. Andersen and S. H. Poulsen, “Evaluation of the Longitudinal Contraction of the Left Ventricle in Normal Subjects by Doppler Tissue Tracking and Strain Rate,” Journal of the American Society of Echocardiography, Vol. 16, No. 7, 2003, pp. 716-723.
 E. Oguz, B. Dagdeviren, T. Bilsel, O. Akdemir, I. Erdinler, A Akyol, T. Ulufer, T. Tezel and K. Gurkan, “Echocardiographic Prediction of Long-Term Response to Biventricular Pacemaker in Severe Heart Failure,” European Journal of Heart Failure, Vol. 4, No. 1, 2002, pp. 83-90. doi:10.1016/S1388-9842(01)00188-X
 P. Steendijk, S. A. Tulner, J. J. Bax, P. V. Oemrawsingh, G. B. Bleeker, L. van Erven, H. Putter, H. F. Verwey, E. E. van der Wall and M. J. Schalij, “Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy: Analysis by Pressure Volume Loops,” Circulation, Vol. 113, 2006, pp. 1295-1304.
 F. B. Tournoux, C. Alabiad, D. Fan, A. A. Chen, M. Chaput, K. Heist, T. Mela, M. Mansour, V. Reddy, J. N. Ruskin, M. H. Picard and J. P. Singh, “Echocardiographic Measures of Acute Haemodynamic Response after Cardiac Resynchronization Therapy Predict Long-Term Clinical Outcome,” European Heart Journal, Vol. 28, No. 9, 2007, pp. 1143-1148. doi:10.1093/eurheartj/ehm050
 T. J. Kolias, K. D. Aaronson and W. F. Armstrong, “Doppler-Derived dp/dt and 2 dp/dt Predict Survival in Congestive Heart Failure,” Journal of the American College of Cardiology, Vol. 36, No. 5, 2000, pp. 1594-1599.
 M. D. Thor Edvardsen, “Early Prediction of Infarct Size by Strain after Coronary Perfusion, Cardiovascular Surgery 2007,” ACC 9/12/2007, American College of Cardiology Foundation.
 T. Edvardsen, B. L. Gerber, J. Garot, D. A. Bluemke, J. A. Lima and O. A. Smiseth, “Quantitative Assessment of Intrinsic Regional Myocardial Deformation by Doppler Strain Rate Echocardiography in Humans: Validation against Three-Dimensional Tagged Magnetic Resonance Imaging,” Circulation, Vol. 106, 2002, pp. 50-56.
 J. L. Harrison and B. D. Prendergast, “Mitral Valve Repair: Benefits of Early Intervention and Future Prospects,” European Journal of Cardiology, Vol. 5, No. 30, 2007.
 Y. T. Tan, F. Wenselburger, E. Lee, et al., “The Pathophysiology of Heart Failure with Normal Ejection Fraction: Exercise Echocardiography Reveals Complex Abnormalities of Both Systolic and Diastolic Ventricular Function Involving Torsion, Untwist, and Longitudinal Motion,” Journal of the American College of Cardiology, Vol. 54, No. 1, 2009, pp. 36-46.