Preoperative left ventricular ejection fraction and left atrium reverse remodeling after mitral regurgitation surgery

Background: Left atrium enlargement has been associated with cardiac events in patients with mitral regurgitation (MR). Left atrium reverse remodeling (LARR) occur after surgical correction of MR, but the preoperative predictors of this phenomenon are not well known. It is therefore important to identify preoperative predictors for postoperative LARR.Methods: We enrolled 62 patients with chronic severe MR (prolapse or flail leaflet) who underwent successful mitral valve surgery (repair or replacement); all with pre-and postoperative echocardiography. LARR was defined as a reduction in left atrium volume index (LAVI) of >= 25%. Stepwise multiple regression analysis was used to identify independent predictors of LARR.Results: LARR occurred in 46 patients (74.2%), with the mean LAVI decreasing from 85.5 mL/m(2) to 49.7 mL/m(2) (p = 25% with a sensitivity of 71.7% and a specificity of 56.3%.Conclusions: LARR occurs frequently after mitral valve surgery and is associated with preoperative LVEF higher than 63.5%.Inst Dante Pazzanese Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilDisciplina Cardiol, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, São Paulo, BrazilWeb of Scienc

Myocardial infarction scar plication in the rat: Cardiac mechanics in an animal model for surgical procedures

Background. the immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined.Methods. Cardiac mechanics were analyzed before and after myocardial infarction scar plication in 11 isolated infarcted rat hearts.Results. Despite a decrease in myocardial stiffness, an increase in chamber stiffness was noted after myocardial infarction scar plication. Systolic function was favored in more than one way. for the same diastolic pressures, maximal developed pressures were higher after myocardial infarction scar plication, and the slope of the systolic pressure-volume relationship was steeper afterwards as compared with before; this means that Frank-Starling recruitment is accentuated in smaller cavities. in addition, the developed net forces needed to generate these pressures were clearly lower afterward than before, indicating reduced ventricular afterload.Conclusions. the study results show that diastolic function is harmed and systolic function is favored by myocardial infarction scar plication. We suggest that preoperative evaluation of the degree of diastolic dysfunction and impairment of the Frank-Starling mechanism may help to identify patients who may have a poor postoperative outcome due to diastolic or systolic dysfunction.Universidade Federal de São Paulo, Dept Physiol, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Physiol, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04022000 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, BR-04022000 São Paulo, BrazilWeb of Scienc

The case for utilizing more strict quantitative Doppler echocardiographic criterions for diagnosis of subclinical rheumatic carditis

Aim: Our aim was to perform a comparative, quantitative and qualitative, analysis of valvar echocardiographic findings in patients with acute rheumatic fever, with or without clinical manifestations of carditis, as compared to healthy controls. Methods and results: We analyzed cross-sectional Doppler echocardiographic images of 31 patients with acute rheumatic fever diagnosed according to the Jones criterions as modified in 1992. of 31 patients, 22 presented with clinical carditis, while 9 had subclinical carditis. the patients, and a control group of 20 healthy individuals, underwent cardiac examination and echocardiographic assessment, assessing quantitative and qualitative findings of mitral and aortic valvar abnormalities. the leaflets of the mitral valve were statistically thicker in those with clinical and subclinical carditis when compared to controls (p less than 0.001). We observed a greater frequency of mitral variance, convergence of mitral flow, and aortic regurgitation for those with clinical and subclinical carditis when compared to controls (p less than 0.001, p less than 0.001 and p equal to 0.003, respectively). Patients with clinical and subclinical carditis had more quantitative and qualitative changes in the parameters than did the controls. Conclusion: Echocardiography is a sensitive method to detect valvar abnormalities in patients with acute rheumatic fever and carditis. Additionally, by using regular standardized criterions, abnormalities that lead to a diagnosis of subclinical carditis are found in those patients with acute rheumatic fever in the apparent absence of cardiac involvement.Universidade Federal de São Paulo, Dept Pediat, Div Allergy Clin Immunol & Rhumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Pediat Cardiol, Discipline Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Div Allergy Clin Immunol & Rhumatol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Pediat Cardiol, Discipline Cardiol, São Paulo, BrazilWeb of Scienc

Left Atrial Dysfunction in Chagas Cardiomyopathy Is More Severe Than in Idiopathic Dilated Cardiomyopathy: A Study with Real-Time Three-Dimensional Echocardiography

Background: Although there is anatomopathologic evidence of atrial involvement in Chagas cardiomyopathy (CCM), the impact in left atrial (LA) function is unknown. the aim of this study was to evaluate LA function in patients with CCM with real-time three-dimensional echocardiography (RT3DE) and to compare it with patients with idiopathic dilated cardiomyopathy (DCM).Methods: A total of 30 patients with CCM, 30 patients with DCM, and 20 normal subjects used as the control group were studied. With the use of RT3DE, we measured LA maximum (maxLAV), minimum, and pre-atrial contraction volumes and calculated total and active LA emptying fractions.Results: Left ventricular ejection fraction and mitral regurgitation were similar in both groups. MaxLAV/m(2) was larger in the CCM group than in the DCM group (76.9 +/- 21.9 mL vs. 59.1 +/- 26.0 mL; P < .01), and both were significantly larger than in the control group (P < .01). Total LA emptying fraction was lower in the CCM group than in the DCM group (0.30 +/- 0.10 vs. 0.40 +/- 0.12; P < .01), and both were lower than in the control group (P = .01). Active LA emptying fraction was also lower in the CCM group than in the DCM group (0.22 +/- 0.09 vs. 0.28 +/- 0.11; P < .01), and both were lower than in the control group (P = .01). the E/e' ratio was higher in the CCM group than in the DCM group (21 +/- 10 vs. 15 +/- 6; P < .01), and both were greater than in the control group (P < .01). in a multiple regression model, the E/e' ratio was the only independent predictor of a worsening active LA emptying fraction.Conclusion: LA function is more compromised in patients with CCM than in patients with DCM. This finding indicates a more diffuse and severe myocardial impairment in Chagas disease that is probably related to increased left ventricular filling pressures and atrial myopathy. (J Am Soc Echocardiogr 2011;24:526-32.)Universidade Federal de São Paulo, Dept Internal Med, Discipline Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Sleep Biol & Med, Dept Psychobiol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Internal Med, Discipline Cardiol, São Paulo, BrazilUniversidade Federal de São Paulo, Discipline Sleep Biol & Med, Dept Psychobiol, São Paulo, BrazilWeb of Scienc