Page 139 - Advanced echocardiography in characterization and management of patients with secondary mitral regurgitation

Summary
In this thesis the role of advanced echocardiography was evaluated in the risk stratification and management of patients with secondary mitral regurgitation (MR).
The general introduction (Chapter 1) provided insights in the role of multimodality imaging in the evaluation of patients with mitral regurgitation referred for transcatheter interventions. An important part of patient selection for transcatheter MV therapies is MR quantification and an accurate assessment of the mitral valve anatomy. These parts cannot be visualized during transcatheter intervention and therefore interventionalist need visualization of the MV apparatus. Three-dimensional imaging techniques, i.e. transesophageal echocardiography, computed tomography, and cardiovascular magnetic resonance, are key in the evaluation of anatomical assessment of the MV apparatus and the suitability of the patient for transcatheter intervention. Fusion imaging is being implemented in catheterization laboratories to precisely guide the procedure and to maximize safety and optimal results.
Part I: epidemiology in secondary mitral regurgitation
In this first part epidemiological characteristics of patients with secondary MR is evaluated. Secondary MR is more prevalent in men than women, but little is known about its association with prognosis. In Chapter 2 the sex distribution of secondary MR and the prognostic differences between sexes has been evaluated. We demonstrated that secondary MR was more frequently seen in men and associated with a worse prognosis. Also ischemic heart failure was more significantly common in men, whereas non-ischemic heart failure was more prevalent in women. The underlying ischemic etiology of secondary MR is known to respond less well to heart failure therapies and may further progress over time, leading to worse outcome.
Part II: Echocardiography and prognosis in secondary mitral regurgitation
In this second part we focused on the role of echocardiography in defining predictors of outcome in patients with secondary mitral regurgitation. Left ventricular (LV) systolic function may be overestimated in patients with secondary MR when using LV ejection fraction (LVEF). LV global longitudinal strain (LVGLS) derived from speckle tracking echocardiography has shown it is more sensitive to detect LV systolic dysfunction. Chapter 3 evaluates the incremental prognostic value of LVGLS. Patients with more impaired LV systolic function according to a LVGLS value of less than 7% showed significantly higher mortality rates. LVGLS also demonstrated to be of incremental prognostic value over LVEF. The results of the current study suggest that LV GLS
137
Ch 7