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

Philips Showcases Integrated Solutions for Cardiovascular Care at TCT 2018
News | Cardiac Imaging | September 20, 2018
At the Transcatheter Cardiovascular Therapeutics (TCT) annual meeting, Sept. 21–25 in San Diego, Philips is showcasing...
Siemens Healthineers Announces First Installation of Acuson Sequoia Ultrasound
News | Ultrasound Imaging | September 20, 2018
September 20, 2018 — Siemens Healthineers announced the first global installation of its newest...
Machine Learning IDs Markers to Help Predict Alzheimer's

Neurologists use structural and diffusion magnetic resonance imaging (MRI) to identify changes in brain tissue (both gray and white matter) that are characteristic of Alzheimer's disease and other forms of dementia. The MRI images are analyzed using morphometry and tractography techniques, which detect changes in the shape and dimensions of the brain and in the tissue microstructure, respectively. In this example, the images show the normal brain of an elderly patient. Image courtesy of Jiook Cha.

News | Neuro Imaging | September 20, 2018
New research has shown a combination of two different modes of magnetic resonance imaging (MRI), computer-based...
LVivo EF Cardiac Tool Now Available for GE Vscan Extend Handheld Mobile Ultrasound
Technology | Cardiovascular Ultrasound | September 19, 2018
DiA Imaging Analysis Ltd. (DiA), a provider of artificial intelligence (AI)-powered ultrasound analysis tools,...
Exact Imaging Partners to Improve Prostate Cancer Detection With Artificial Intelligence
News | Prostate Cancer | September 19, 2018
Exact Imaging, makers of the ExactVu micro-ultrasound platform, has partnered with U.K.-based Cambridge Consultants to...
Acuson Sequoia
News | Ultrasound Imaging | September 12, 2018
Siemens Healthineers announced the first global installation of its newest ultrasound system, the...
Mount Sinai Serves as Official Medical Services Provider for 2018 U.S. Open
News | Orthopedic Imaging | September 06, 2018
For the sixth consecutive year, Mount Sinai will serve as the official medical services provider for the 2018 U.S. Open...
Konica Minolta Provides Sonimage HS1 Ultrasound for AAPM&R Hands-on Learning Course
News | Ultrasound Imaging | September 05, 2018
Konica Minolta Healthcare Americas recently provided ultrasound systems for The American Academy for Physical Medicine...
PET Imaging Agent Predicts Brain Tau Pathology, Alzheimer's Diagnosis
News | PET Imaging | September 05, 2018
Eli Lilly and Co. and Avid Radiopharmaceuticals Inc. announced a Phase 3 study of positron emission tomography (PET)...
Check-Cap Announces Interim Results of European Study of C-Scan System Version 3
News | Colonoscopy Systems | September 04, 2018
Check-Cap Ltd. announced the interim results for its post-CE approval study of the C-Scan system Version 3, an...