Cardiac resynchronization therapy (CRT) is an established therapy for patients with advanced congestive heart failure and prolonged QRS duration, aiming at correcting dyssynchrony in the left ventricle (LV). Apart from the beneficial effects on cardiac function and LV reverse remodeling, reduction in functional MR has been observed by Doppler echocardiography after CRT. On the other hand, functional mitral regurgitation (MR) in fact varies over the cardiac cycle that a biphasic pattern has been reported, i.e. early- and late-systolic peaks with a mid-systolic decrease in regurgitant flow. Nevertheless, it remains to be explored whether (1) the improvement of MR leads to a greater extent of LV reverse remodeling; (2) the different components (i.e. early- and late-systolic) of MR improve and their predictors if any. / Despite comparable ejection fraction, higher degree of functional MR was associated with further impairment in short-axis myocardial deformation (circumferential and radial), but not with long-axis myocardial deformation. The degree of LV basal rotation was also lower in the MR patient group. Furthermore, the decrease in myocardial deformation was associated with greater extent of LV remodeling. / In conclusion, LV global mechanical dyssynchrony play a role in determining the severity of functional MR in addition to mitral leaflet tenting in patients with LV systolic dysfunction. Functional MR is associated with further impairment of myocardial deformation, but with differential change in individual component of myocardial deformation. CRT reduces functional MR in both early- and late-systolic phases, by way of improvement in LV remodeling, LV dyssynchrony and mitral leaflet tenting. Meanwhile, the improvement of MR contributes to LV reverse remodeling after CRT. (Abstract shortened by UMI.) / The improvement of functional MR was an independent predictor of LV reverse remodeling after CRT. The extent of LV reverse remodeling (reduction of LV end-systolic volume) was greatest in patients with improvement of MR, followed by those with "mild or no" MR at baseline, and was least in those without improvement of MR. CRT reduced functional MR by reducing both its early- and late-systolic components in heart failure patients. The reductions in LV end-systolic volume and dyssynchrony were related to the improvement of early-systolic MR, while the improvement of late-systolic MR was attributable to the reductions in mitral leaflet tenting and LV dyssynchrony. / The main findings were as follows: LV global systolic dyssynchrony served as an independent predictor for the presence of significant functional MR in patients with LV systolic dysfunction. Although mitral valvular tenting area was the most powerful predictor, LV global systolic dyssynchrony added incremental value to mitral valve tenting area in predicting the presence of significant functional MR. / We performed echocardiography with TDI and 2DSTE in 147 patients of both ischemic and non-ischemic etiologies with LV systolic dysfunction (defined as LV ejection fraction <50%) and 45 normal controls. MR severity, displacement of papillary muscle, mitral annular dilation and dysfunction, mitral leaflet tenting, LV remodeling and function were assessed by 2D and Doppler echocardiography. LV mechanical dyssynchrony indices were derived from TDI velocity. Myocardial strain (i.e. amount of deformation) in longitudinal, circumferential and radial directions and torsion (opposite rotational movement between apex and base of the heart) were measured by 2DTSE. / Liang, Yujia. / "October 2009." / Adviser: Cheuk man Yu. / Source: Dissertation Abstracts International, Volume: 72-01, Section: B, page: . / Thesis (Ph.D)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 169-193). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.
| Identifer | oai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_344452 |
| Date | January 2010 |
| Contributors | Liang, Yujia., Chinese University of Hong Kong Graduate School. Division of Medical Sciences. |
| Source Sets | The Chinese University of Hong Kong |
| Language | English, Chinese |
| Detected Language | English |
| Type | Text, theses |
| Format | electronic resource, microform, microfiche, 1 online resource (xiii, 193 leaves : ill.) |
| Rights | Use of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/) |
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