News | Cardiovascular Ultrasound | July 20, 2016

Pre-operative Echo May Predict Mitral Valve Surgery Outcomes

Study finds torsion of the heart visualized via ultrasound can help with patient selection

mitral valve surgery outcomes, twisting of the heart, echocardiography, NICSMR, JACC Basic to Translational Science

July 20, 2016 — A novel study has found a simple pre-operative echocardiographic measurement of the amount of torsion of the heart predicted outcomes of mitral valve surgery in some heart failure patients. The study was published in JACC: Basic to Translational Science.

The selection of appropriate candidates for mitral surgery among symptomatic patients with nonischemic, chronic secondary severe mitral regurgitation (NICSMR) can be challenging. This study demonstrates that assessment of left ventricular torsion — a twisting motion — may be useful for the prediction of post-mitral surgery outcomes in some patients.

Researchers examined 50 consecutive symptomatic NICSMR patients for a median follow-up of 2.5 years after mitral surgery. All patients had advanced heart failure symptoms and had already received the maximum guideline-directed medical therapy for more than six months. Baseline left ventricular size, shape and mass tended to be larger and more spherical in those who died, but not significantly so, while left ventricular torsion was higher in survivors. Patients were divided into three groups: preserved left ventricular torsion, lost left ventricular torsion, or patients with a wide QRS measurement who received cardiac resynchronization therapy. 

Patients received either mitral valve repair or mitral valve replacement. Two years after surgery, 19 patients had died. Researchers determined that in patients with NICSMR and a narrow QRS width, preserved left ventricular torsion may be a better predictor of post-mitral surgery survival, while conversely, lost left ventricular torsion may lead to a poor post-surgical outcome. The post-surgical survival results were intermediate in patients with a wide QRS. Patients who received cardiac resynchronization therapy prior to mitral surgery showed significantly worse two-year survival than those who received the procedure during mitral surgery. However, the two groups had similar left ventricular torsion.

“These findings show that lost left ventricular torsion and previously administered cardiac resynchronization therapy appear to be markers of poor survival after mitral surgery in patients with NICSMR,” said Yuichi Notomi, M.D., from the division of cardiovascular imaging, department of cardiology at The Hayama Heart Center in Kanagawa, Japan, and the lead author of the study. “We also found that reverse remodeling was only observed in patients with preserved left ventricular torsion, demonstrating that lost left ventricular torsion and wide QRS were markers of no reverse remodeling viability.” 

This study demonstrates that for patients with left-ventricular torsion and a narrow QRS measurement, mitral surgery is an acceptable option and that left ventricular torsion can help to predict post-mitral surgery outcomes in patients with a narrow QRS but not in those with a wide QRS.

“Mechanistically, this study suggests that the loss of torsion in patients with heart failure may reflect irreversible structural damage to the heart which would prevent the heart from recovering after corrective surgery,” said Douglas L. Mann, M.D., FACC, editor-in-chief of JACC: Basic to Translational Science. “If correct, this will have much broader implications than improvement after mitral valve surgery since it may predict which patients with heart failure may get better on medications.” 

Mann added that these findings will need confirmation as the analysis was retrospective and took place in a small number of patients. 

For more information: www.basictranslational.onlinejacc.org

Related Content

This is an example of 3-D ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

This is an example of TriVu ultrasound imaging on a breast, designed to help increase efficiency and diagnostic accuracy in any practice. Image courtesy of Hologic.

Feature | Breast Imaging | September 15, 2021 | By Jennifer Meade
The...
Us2.ai, a Singapore-based medtech firm backed by Sequoia India and EDBI, has received U.S. Food and Drug Administration (FDA) clearance for Us2.v1, a completely automated AI decision support tool for cardiac ultrasound.
News | Cardiovascular Ultrasound | September 14, 2021
September 14, 2021 – Us2.ai, a Singapore-based medtech firm backed by Sequoia India and EDBI, has received U.S.
Laws designed to help women with increased risk for missed breast cancer diagnoses may help catch the disease earlier, according to Penn State College of Medicine researchers.

Getty Images | AleksandarNakic

News | Breast Imaging | September 09, 2021
September 9, 2021 — Laws designed to help women with increased risk for...

Image of a STING protein, courtesy of UCLA Jonsson Comprehensive Cancer Center

News | PET Imaging | September 08, 2021
September 8, 2021 — A new study from scientists at the UCLA Jonsso...
62-Year-Old Woman Who Underwent Hysterectomy for Uterine Cancer: Sagittal chest CT images demonstrate measurement of right (A) and left (B) lung length at hilar level from apex to diaphragmatic dome. Right lung length was 20.1 cm for reader 1 and 20.0 cm for reader 2; left lung length was 21.7 cm for reader 1 and 21.3 cm for reader 2. Patient did not require postoperative mechanical ventilation.

62-Year-Old Woman Who Underwent Hysterectomy for Uterine Cancer: Sagittal chest CT images demonstrate measurement of right (A) and left (B) lung length at hilar level from apex to diaphragmatic dome. Right lung length was 20.1 cm for reader 1 and 20.0 cm for reader 2; left lung length was 21.7 cm for reader 1 and 21.3 cm for reader 2. Patient did not require postoperative mechanical ventilation.

News | Computed Tomography (CT) | September 07, 2021
Neuroscientists at the Beckman Institute for Advanced Science and Technology carried out comparative studies to determine safe operating conditions for multiband EEG-fMRI imaging while maintaining acceptable data quality standards

A team of psychologists and neuroscientists at the Beckman Institute for Advanced Science and Technology including Sepideh Sadaghiani, Maximillian Egan, Ryan Larsen, and Brad Sutton published a study to establish safe use of electroencephalography coupled with newly developed functional MRI sequences. Image courtesy of the Beckman Institute for Advanced Science and Technology.

News | Magnetic Resonance Imaging (MRI) | September 07, 2021
September 7, 2021 — A team of psychologists and neuroscientists at the Beckman Institute for Advanced Science and Tec
Mount Sinai scientists created an AI-based, automated system that learns to read patient data from electronic health records. Here the system identified dementia cases (purple dots) from a database of nearly 2 million patients (blue dots). Courtesy of the Glicksberg lab, Mount Sinai, N.Y., N.Y.

Mount Sinai scientists created an AI-based, automated system that learns to read patient data from electronic health records. Here the system identified dementia cases (purple dots) from a database of nearly 2 million patients (blue dots). Courtesy of the Glicksberg lab, Mount Sinai, N.Y., N.Y.

News | Artificial Intelligence | September 02, 2021
September 2, 2021 — In an article published in the journ...
Cedars-Sinai Cancer researchers have discovered that intestinal microorganisms help regulate anti-tumor immune responses to radiation treatments.

Getty Images

News | Radiation Therapy | September 01, 2021
September 1, 2021 — The study, published on Aug.