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European Journal of Echocardiography Advance Access originally published online on October 8, 2007
European Journal of Echocardiography 2008 9(4):516-521; doi:10.1016/j.euje.2007.08.007
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Published on behalf of the European Society of Cardiography. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Early detection of right ventricular systolic dysfunction by using myocardial acceleration during isovolumic contraction in patients with mitral stenosis

Yelda Tayyareci*, Yilmaz Nisanci, Berrin Umman, Aytac Oncul, Selen Yurdakul, Ibrahim Altun, Sabahattin Umman and Zehra Bugra

Istanbul University, Istanbul Faculty of Medicine, Department of Cardiology, Capa, Istanbul, Turkey

Received 6 May 2007; accepted after revision 22 August 2007; online publish-ahead-of-print 8 October 2007.

* Corresponding author. Tel: + 90 533 3623772; fax: + 90 358 5140830. E-mail addresses: yeldatayyareci{at}hotmail.com, ytayyareci{at}yahoo.com (Y. Tayyareci).


  Abstract

Aim: The aim of the study was to determine if the tissue Doppler imaging (TDI)-derived myocardial acceleration during isovolumic contraction (IVA) of tricuspid lateral annulus could be used in early detection of RV systolic dysfunction in patients with mitral stenosis (MS), before the clinical signs of systemic venous congestion occur.

Methods: One hundred and twelve patients with rheumatic MS without relevant regurgitation and 60 control subjects were enrolled in the study. Conventional echocardiographic parameters (mitral valve area, transmitral diastolic gradients, pulmonary artery pressure, RV fractional shortening, pulmonary flow acceleration time, tricuspid annular plane systolic excursion) and TDI-derived systolic velocities of tricuspid annulus (isovolumic myocardial acceleration: IVA, peak myocardial velocity during isovolumic contraction: IVV, peak systolic velocity during ejection period: Sa and RV Tei index) were recorded from all patients.

Results: TDI-derived IVA, IVV, Sa and Tei index were found to be significantly decreased in patients with MS. IVA was the only parameter which had a significant negative correlation with the traditional echocardiographic parameters and RV Tei index in patients with MS. Additionally, in subgroup analyses, IVA was significantly lower in patients with severe degree of MS.

Conclusion: TDI-derived right ventricular IVA may be used as an adjunctive, reliable, noninvasive parameter for the early detection of right ventricular systolic dysfunction in patients with MS but without signs of systemic venous congestion.

Keywords: Right ventricular systolic function; Isovolumic myocardial acceleration; Tissue Doppler imaging; Echocardiography


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