TY - JOUR
T1 - MRI-based multiparametric strain analysis predicts contractile recovery after aortic valve replacement for aortic insufficiency
AU - Brady, Beckah D.
AU - Knutsen, Andrew K.
AU - Ma, Ningning
AU - Gardner, Rita
AU - Taggar, Ajay K.
AU - Cupps, Brian P.
AU - Kouchoukos, Nicholas T.
AU - Pasque, Michael K.
PY - 2012/7
Y1 - 2012/7
N2 - Background: Guidelines for referral of chronic aortic insufficiency (AI) patients for aortic valve replacement (AVR) suggest that surgery can be delayed until symptoms or reduction in left ventricular (LV) contractile function occur. The frequent occurrence of reduced LV contractile function after AVR for chronic AI suggests that new contractile metrics for surgical referral are needed. Methods: In 16 chronic AI patients, cardiac MRI tagged images were analyzed before and 21.5 ± 13.8 months after AVR to calculate LV systolic strain. Average measurements of three strain parameters were obtained for each of 72 LV regions, normalized using a normal human strain database (n = 63), and combined into a composite index (multiparametric strain z score [MSZ]) representing standard deviation from the normal regional average. Results: Preoperative global MSZ (72-region average) correlated with post-AVR global MSZ (R2= 0.825, p < 0.001). Preoperative global MSZ also predicts improvement of impaired regions (N = 271 regions from 14 AI patients, R 2= 0.392, p < 0.001). Preoperative MRI-based LV ejection fraction (LVEF) is also predictive (r = 0.410, p < 0.001). Although global preoperative MSZ had a significantly higher correlation than preoperative LVEF with improvement of injured regions (p < 0.001), both measures convey the same phenomenon. Conclusions: Global preoperative MRI-based multiparametric strain predicts global strain postoperatively, as well as improvement of regions (n = 72 per LV) with impaired contractile function. Global contractile function is an important correlate with improvement in regionally impaired contractile function, perhaps reflecting total AI volume-overload burden (severity/duration of AI).
AB - Background: Guidelines for referral of chronic aortic insufficiency (AI) patients for aortic valve replacement (AVR) suggest that surgery can be delayed until symptoms or reduction in left ventricular (LV) contractile function occur. The frequent occurrence of reduced LV contractile function after AVR for chronic AI suggests that new contractile metrics for surgical referral are needed. Methods: In 16 chronic AI patients, cardiac MRI tagged images were analyzed before and 21.5 ± 13.8 months after AVR to calculate LV systolic strain. Average measurements of three strain parameters were obtained for each of 72 LV regions, normalized using a normal human strain database (n = 63), and combined into a composite index (multiparametric strain z score [MSZ]) representing standard deviation from the normal regional average. Results: Preoperative global MSZ (72-region average) correlated with post-AVR global MSZ (R2= 0.825, p < 0.001). Preoperative global MSZ also predicts improvement of impaired regions (N = 271 regions from 14 AI patients, R 2= 0.392, p < 0.001). Preoperative MRI-based LV ejection fraction (LVEF) is also predictive (r = 0.410, p < 0.001). Although global preoperative MSZ had a significantly higher correlation than preoperative LVEF with improvement of injured regions (p < 0.001), both measures convey the same phenomenon. Conclusions: Global preoperative MRI-based multiparametric strain predicts global strain postoperatively, as well as improvement of regions (n = 72 per LV) with impaired contractile function. Global contractile function is an important correlate with improvement in regionally impaired contractile function, perhaps reflecting total AI volume-overload burden (severity/duration of AI).
UR - http://www.scopus.com/inward/record.url?scp=84863846888&partnerID=8YFLogxK
U2 - 10.1111/j.1540-8191.2012.01477.x
DO - 10.1111/j.1540-8191.2012.01477.x
M3 - Article
C2 - 22612862
AN - SCOPUS:84863846888
SN - 0886-0440
VL - 27
SP - 415
EP - 422
JO - Journal of cardiac surgery
JF - Journal of cardiac surgery
IS - 4
ER -