Mitral Annular Plane Systolic Excursion as a Surrogate for Left Ventricular Ejection Fraction in Patients with Impaired Systolic Function

Abstract

SUMMARY he mitral valvular apparatus is a complex anatomical and functional entity. One or more flaws in its components can result in MR. MR can be divided into primary and secondary categories. In primary lesions, one or more of the components of the mitral valve (MV) itself is deranged, whereas in secondary lesions, geometric and/or functional changes of the left ventricle (LV) are the core of the problem. Assessment of the mitral valve by 2D echocardiography requires the operator to obtain multiple views through all segments of the two leaflets. This requires considerable expertise and experience, but even then errors in interpretation may occur. Compared to information obtained from 2D echocardiography, 3DE has provided additional morphologic data in the visualization of the mitral valve apparatus with its elliptical and saddle-like shape and in the characterization and quantification of mitral regurgitation. Left ventricular (LV) volumes, mass and ejection fraction (EF) are the most widely used indexes to assess the global LV function and ventricular response to pressure and volume overload. Although these indexes can be measured using a number of conventional M-mode and 2-dimensional (2D) T Summary  137 echocardiographic methods, 3-dimensional (3D) echocardiography (3DE) is superior to the conventional M-mode and 2D methods for assessment of LV volumes, mass and EF. The cardiac hormonal system is activated in response to increased wall stretch due to LV pressure or volume overload. Amino-terminal portion of pro BNP (NT-pro BNP) was established marker of left ventricular (LV) systolic and diastolic dysfunction. The aim of this study was to compare Real-time 3D echocardiography versus 2D echocardiography in the assessment of mitral valve morphology and hemodynamic changes in children with mitral valve regurgitation. This cross sectional study was conducted on 30 patients with mitral valve regurge following up in Pediatric Cardiology Clinic, Children’s Hospital, Ain-Shams University in the period from January 2014 to January 2015. They were compared to 30 age and sex matched children as control group. The age of studied patients ranged from 3 years to 18years with a mean age of 11.6 ± 3.48 years. Sixty three percent of studied patients (63%) were females and (37%) were males. All patients were subjected to the following:  Detailed history taking and through clinical examination. Summary  138  Assessment of serum level of Human N-Terminal pro- B type Natriuretic Peptide (BNP) by ELISA (Enzyme Linked Immunosorbant Assay).  Initially routine diagnostic imaging was performed and included Motion mode (M mode), Two dimensional echo (2D), Pulsed wave (PW), Continuous wave (CW), as well as Color flow (CF) Doppler studies in the apical 4 chamber (A4C), apical 5 chamber (A5C), Parasternal long axis (PLAX) and short axis (PSAX) views.  The following parameters were assessed by M-mode, 2DE and RT-3DE of left ventricle in short axis parasternal views using a commercially available cardiac ultrasound unit, device module (Vivid E9, Vingmed, Horton, Norway) and they were indexed to BSA as follows:- • Left Ventricular End Systolic Volume (LVESV (ml). • Left Ventricular End Diastolic Volume (LVEDV (ml). • Ejection Fraction (EF %) • Left ventricular mass index (LVMI (g/m²).  Assessment of Mitral valve area, affection of mitral valve leaflets, quantification of mitral regurgitation severity using the proximal isovelocity surface area (PISA) method as well as grading of MR by 2D echo Doppler and RT-3D echocardiography.