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European Journal of Echocardiography Advance Access originally published online on September 20, 2009
European Journal of Echocardiography 2009 10(8):961-967; doi:10.1093/ejechocard/jep114
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation

Masaki Izumo1,*, Patrizio Lancellotti2, Kengo Suzuki1, Seisyou Kou1, Takashi Shimozato1, Akio Hayashi1, Yoshihiro J. Akashi1, Naohiko Osada1, Kazuto Omiya1, Sachihiko Nobuoka3, Eiji Ohtaki1 and Fumihiko Miyake1

1 Division of Cardiology, Department of Internal Medicine, St Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, Kanagawa 216-8511, Japan
2 Department of Cardiology, University Hospital of Liège, CHU Sart Tilman, Liège, Belgium
3 Department of Laboratory Medicine, St Marianna University School of Medicine, Kawasaki, Japan

Received 3 May 2009; accepted after revision 20 August 2009; online publish-ahead-of-print 20 September 2009.

* Corresponding author. Tel: +81 44 977 8111; fax: +81 44 976 7093. E-mail address: m2izumo{at}marianna-u.ac.jp


  Abstract

Aims: Left ventricular (LV) shape and LV dyssynchrony are two cofactors associated with functional mitral regurgitation (MR) in patients with heart failure. Both can be accurately examined by real-time three-dimensional echocardiography (3DE). We examined the relationship between dynamic MR and exercise-induced changes in LV shape and synchronicity using 3DE.

Methods and results: Fifty patients with systolic LV dysfunction underwent 2D and 3D quantitative assessment of LV function, shape, and synchronicity at rest and during symptom-limited exercise test. According to the magnitude of change in MR, patients were divided into EMR group (15 patients, 30%), if the degree of MR increased during test, and NEMR group. During exercise, the changes in LV volumes and ejection fraction were similar in both groups, whereas changes in mitral valvular deformation parameters, in LV sphericity index, and in the extent of LV dyssynchrony were more pronounced in the EMR group. At rest, only the 3D sphericity index could distinguish the two groups. By stepwise multiple regression model, dynamic changes in the systolic dyssynchrony index, sphericity index, and coaptation distance were associated with dynamic MR (r2 = 0.45, P = 0.012).

Conclusion: Dynamic MR during exercise is related to the 3D changes in LV shape and in LV synchronicity.

Keywords: Left ventricular dyssynchrony; Mitral regurgitation; Exercise; 3D echocardiography


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