Key result
Early LV laminar plane shifts after surgery for primary MR persist and negatively correlate with LVEF.
Why the study?
When LV laminar sheet arrangement changes in primary mitral regurgitation and whether it reverts to normal after mitral valve repair was unknown.
Does mitral valve surgery reverse the shift in LV laminar planes and improve LV twist and LVEF in patients with primary mitral regurgitation?
Observational (n=157)
No
Does mitral valve surgery reverse the shift in LV laminar planes and improve LV twist and LVEF in patients with primary mitral regurgitation?
In patients with primary mitral regurgitation, a shift in LV laminar planes persists up to two years after mitral valve surgery and negatively correlates with post-operative LVEF, suggesting a mechanical basis for post-surgical LVEF decline.
Persistent LV laminar shifts after mitral valve surgery associate with lower LVEF; hypothesis-generating for mechanical targets in primary MR.
Background The double helical direction of LV laminar sheets from endocardium to epicardium allows for wringing motion or LV twist. This provides a major component to LV wall thickening, stroke volume, and ejection fraction (EF). When this laminar sheet arrangement changes in Primary Mitral Regurgitation (PMR) and whether it reverts to normal after mitral valve repair is unknown. Methods Normal subjects (n=55) PMR patients had cardiac magnetic resonance imaging (CMR) with tissue tagging and 3-dimensional (3-D) analysis. They were grouped as asymptomatic moderate (n=23) and severe PMR (n=25) by regurgitant volume (RV) and pre-surgery (n=54) with post-surgery follow up at six, 12, and 24 months. Amplitude and directional vector of longitudinal (Ell), circumferential (Ecc), and maximal shortening were computed along with principle strain angles (Ecc°, Ell°, and Err°) at basal, mid, and distal LV levels. Results Asymptomatic moderate (RV 35 ± 16 ml; LVEF 62 ± 6%) and severe (RV 55 ±16 ml; LVEF 63 ± 6%) and symptomatic pre-surgery (RV 61 ± 29 ml; LVEF 63 ± 8%) had similar increases in mid LV 3-D radius to wall thickness (R/T), decrease in LV mass to volume (M/V) and sphericity index (SI) vs. normal. Radial longitudinal shear strain and mid LV Ecc° and EII° angles increased in all PMR groups, consistent with a shift in LV laminar plane direction and decreased LV SI. Post-surgery, LV end-diastolic (ED) volume, LVED M/V and 3-D R/T returned to normal within two years; however, mid LV circumferential, longitudinal, and maximal shortening decrease below normal. LV Ecc° and Ell° angles, and SI are unchanged from pre-surgery. LVEF decreased post-surgery and had a negative correlation with LV twist at six (r 2 = 0.30, p < 0.001), 12, (r 2 = 0.33, p < 0.001) and 24 months (r 2 = 0.38, p < 0.001) post-surgery. Conclusion Early changes in Ecc° and Ell° angles, radial longitudinal shear strain, and LV spherical dilatation are consistent with a shift of LV laminar planes that persists after surgery. The extent to which this affects LV twist may underlie a heretofore explanation underlying the decrease in LVEF after surgery for PMR.
No takes yet. Share an insight, caveat, or question.
Dell’Italia et al. (2025) conducted an observational in Primary Mitral Regurgitation (n=157). Mitral valve surgery vs. Pre-surgery baseline and normal controls was evaluated on Correlation between post-surgical LVEF and LV twist at 24 months (r2 = 0.38, p=<0.001). Following mitral valve surgery for primary mitral regurgitation, early shifts in left ventricular laminar planes persist and negatively correlate with post-surgical left ventricular ejection fraction (r2 = 0.38 at 24 months, p<0.001).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: