Fixed-apex mitral annular descent correlates better with left ventricular systolic function than does free-apex left ventricular long-axis shortening - 24/08/11

Doi : 10.1016/j.echo.2003.11.007

Filiberto Rodriguez, MD ^a, Frederick A. Tibayan, MD ^a, Julie R. Glasson, MD ^a, David Liang, MD, PhD ^b, George T. Daughters, MS ^a,^c, Neil B. Ingels, PhD ^a,^c, D.Craig Miller, MD ^a,^⁎
^a Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA, (F.R., F.A.T., J.R.G., G.T.D., N.B.I., D.C.M.)
^b Division of Cardiovascular Medicine (D.L.), Stanford University School of Medicine, Stanford, California, USA
^c Laboratory of Cardiovascular Physiology and Biophysics, Research Institute of the Palo Alto Medical Foundation, Palo Alto, California, USA (G.T.D., N.B.I.)

^*Reprint requests: D. Craig Miller, MD, Department of Cardiovascular and Thoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247, USA

Abstract

Echocardiographic measures of mitral annular descent (MAD) assume a fixed left ventricular (LV) apex throughout the cardiac cycle, ignoring the apical component of LV long-axis shortening (LAS). We tested whether apical motion contributes significantly to LAS, making LAS a better surrogate of LV systolic function than MAD. Three-dimensional LV systolic MAD, LAS, and apical motion were measured in sheep using implanted radiopaque markers and biplane videofluoroscopy. End-diastolic volume-stroke work relationship (preload recruitable stroke work) was computed as a load-independent index of LV systolic function. Apical motion was 1.4 ± 0.8 mm, representing 22% of LAS (P < .05). Linear regression demonstrated that MAD correlated slightly better with preload recruitable stroke work (r = 0.808) than LAS (r = 0.792, both P < .001). Receiver operating characteristic curves demonstrated MAD was more accurate in predicting depressed LV function than LAS (93% vs 84%, respectively). Although LV apical motion contributed significantly to LAS, MAD measured with a fixed-apex assumption, as currently done echocardiographically, correlated more closely with LV preload recruitable stroke work.

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Plan

Changes in global LV systolic function

LAS

LAS as a surrogate for LV systolic function

Discussion

Study limitations

Supported in part by grants HL-29589 and HL-67025 from the National Heart, Lung, and Blood Institute (NHLBI). Drs Rodriguez, Tibayan, and Glasson were Carl and Leah McConnell Cardiovascular Surgical Research Fellows. Dr Rodriguez was supported by grant HL67025-01S1 from the NHLBI and was also a recipient of the American College of Surgeons Resident Research Scholarship Award. Dr Tibayan was supported by NHLBI Individual Research Service Award HL-67563.

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Vol 17 - N° 2

P. 101-107 - février 2004 Retour au numéro

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Fixed-apex mitral annular descent correlates better with left ventricular systolic function than does free-apex left ventricular long-axis shortening - 24/08/11

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