Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes in Friedreich's ataxia.
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Adolescent↗
Biomedical subjects
Bart Bijnens
Publications and source records attributed to Bart Bijnens.
Defining the transmurality of a chronic myocardial infarction by ultrasonic strain-rate imaging: implications for identifying intramural viability: an experimental study.
BACKGROUND: In a correlative functional/histopathologic study, we investigated the regional deformation characteristics of both chronic nontransmural and transmural infarctions before and after a dobutamine challenge. METHODS AND RESULTS: After stenosing copper-coated stent implantation to produce circumflex artery endothelial proliferation, 18 pigs were followed up for 5 weeks. Posteuthanasia histology showed 10 to have a nontransmural and 8 a transmural infarction. Eight nonstented animals served as controls. Regional radial function was monitored by measuring ultrasound-derived peak systolic strain rates (SR(SYS)) and systolic strains (epsilon(SYS)) (1) before stent implantation and (2) at 5 weeks, at baseline (bs) and during an incremental dobutamine infusion. In controls, dobutamine induced a linear increase in SR(SYS) (dobutamine: bs, 4.8+/-0.4 s(-1); 20 microg x kg(-1) x min(-1), 9.9+/-0.7 s(-1); P<0.0001) and an initial increase of epsilon(SYS) at low dose (bs, 58+/-5%; at 5 microg x kg(-1) x min(-1), 78+/-6%; P<0.05) but a subsequent decrease during higher infusion rates. In the nontransmural group, bs SR(SYS) and epsilon(SYS) were significantly lower than prestent values (SR(SYS), 2.9+/-0.5 s(-1) and epsilon(SYS), 32+/-6%, P<0.05 versus prestent). During dobutamine infusion, SR(SYS) increased slightly at 5 microg x kg(-1) x min(-1) (4.7+/-0.6 s(-1), P<0.05) but fell during higher infusion rates, whereas epsilon(SYS) showed no change. For nontransmural infarctions, transmural scar extension correlated closely with epsilon(SYS) at bs (r=0.88). For transmural infarctions, SR(SYS) at bs was significantly reduced and epsilon(SYS) was almost not measurable (SR(SYS), 1.8+/-0.3 s(-1); epsilon(SYS), 3+/-4%). Both deformation parameters showed no further change during the incremental dobutamine infusion. CONCLUSIONS: Ultrasonic deformation values could clearly differentiate chronic nontransmural from transmural myocardial infarction. The transmural extension of the scar could be defined by the regional deformation response.
Animals↗
One-dimensional ultrasonic strain and strain rate imaging: a new approach to the quantitation of regional myocardial function in patients with aortic stenosis.
Abnormalities in regional left ventricular (LV) function in aortic stenosis (AS) have yet to be appropriately characterized. One-dimensional strain (epsilon) and strain rate imaging (SRI), new ultrasound (US) indices for quantifying regional wall deformation, might allow this. The aims of this study were 1. to define regional radial and longitudinal epsilon /SR in AS; 2. to establish if they are related to the severity of the disease; and 3. to determine if regional deformation is further altered by coexistent coronary artery disease (CAD). A total of 40 patients were studied: Group I with isolated AS (10 women, 10 men; mean age 66 years) and group II with AS and concomitant CAD (CAD/AS) (13 women, 7 men, mean age 68 years). Data were compared to 20 age-matched healthy people (N). Regional systolic maximal velocity/SR and end-systolic and maximal epsilon were measured. The maximal systolic velocity/SR in AS and CAD/AS patients were significantly reduced compared to N. The two patient groups could be further differentiated by end-systolic and maximal epsilon, which demonstrated a further reduction in both epsilon indices in CAD/AS (i.e., maximal radial epsilon 29.3%, AS; 23.7%, CAD/AS; 40.4%, N; AS and CAD/AS vs. N, AS vs. CAD/AS, p < 0.05). Indices of radial and longitudinal deformation correlated both with aortic valve area (AVA) and stroke volume (SV) (i.e., radial maximal epsilon and AVA, r = 0.77, p < 0.05). A significant correlation was also found between epsilon indices and the severity of left anterior descending (LAD) or circumflex artery (CX) coronary artery. Regional myocardial deformation in AS is abnormal. In the absence of CAD, the degree of abnormality correlates with aortic valve area (AVA). The severity of the disease was best expressed by changes in regional epsilon. In CAD/AS patients, there was a significant further reduction in end-systolic and maximal epsilon. These changes correlated with the severity of coronary narrowing in the subtending vessel.
Adult↗
Can regional strain and strain rate measurement be performed during both dobutamine and exercise echocardiography, and do regional deformation responses differ with different forms of stress testing?
BACKGROUND: Regional strain (epsilon) and strain rate (SR) measurement could be the optimal approach to quantifying stress echocardiography images. However, signal noise could preclude their use. Study aims Our aim was to compare the feasibility of regional peak systolic (p) velocity (Vel), pSR/epsilon measurement, and their normal responses during upright (group 1, n = 10) and supine (group 2, n = 10) bicycle exercise and (group 3, n = 10) dobutamine stress. METHODS: For each type of stress study, pVel/pSR/epsilon data were acquired at baseline, low (100-120 bpm), and peak (140-160 bpm) heart rate (HR); and during recovery. RESULTS: During dobutamine pVel/pSR/epsilon were interpretable in >95% of segments at every stress stage, whereas in groups 1 and 2 pSR/epsilon responses were noninterpretable in >36% of segments (P <.0002). The highest proportions of data exclusions were from the lateral and anterior walls. In all groups, regional systolic pVel and SR values increased linearly and reached maximal value at peak HR (P <.0006 vs baseline). Pepsilon showed a biphasic response, initially increasing at low HR, and then remaining constant or falling at peak HR. CONCLUSION: PSR/pepsilon quantification of stress echocardiography may currently be restricted to dobutamine as increased signal noise precludes adequate data acquisition during exercise. For all forms of stress both pSR and pVel increased linearly, whereas pepsilon response was biphasic as a result of the reduced filling at higher HRs.
Adult↗
Towards ultrasound cardiac image segmentation based on the radiofrequency signal.
In echocardiography, the radio-frequency (RF) image is a rich source of information about the investigated tissues. Nevertheless, very few works are dedicated to boundary detection based on the RF image, as opposed to envelope image. In this paper, we investigate the feasibility and limitations of boundary detection in echocardiographic images based on the RF signal. We introduce two types of RF-derived parameters: spectral autoregressive parameters and velocity-based parameters, and we propose a discontinuity adaptive framework to perform the detection task. In classical echographic cardiac acquisitions, we show that it is possible to use the spectral contents for boundary detection, and that improvement can be expected with respect to traditional methods. Using the system approach, we study on simulations how the spectral contents can be used for boundary detection. We subsequently perform boundary detection in high frame rate simulated and in vivo cardiac sequences using the variance of velocity, obtaining very promising results. Our work opens the perspective of a RF-based framework for ultrasound cardiac image segmentation and tracking.
Algorithms↗
Influence of work rate on the determinants of oxygen deficit during short-term submaximal exercise: implications for clinical research.
OBJECTIVE: The effect of increasing work rate was studied on the determinants of the oxygen deficit. METHODS: Exercise testing was performed on a treadmill and gas exchange was measured on a breath-by-breath basis. Eleven healthy subjects, aged 18-25 years, performed three square wave exercise tests of different intensity. Before exercise, gas exchange was measured at rest in the standing position for 3 min, followed by a 6-min square wave exercise test, randomly assigned at 4, 8 or 12% inclination. Immediately after exercise the recovery gas exchange was determined for 3 min. To calculate oxygen deficit, the oxygen uptake (O2) values at onset of exercise were subtracted from the steady-state value, the differences were cumulated and expressed as a percentage of the total oxygen cost for the 6-min exercise. RESULTS: The oxygen deficit increased significantly (P<0.001) with increasing work rate (6.1 +/- 1.4% for 4%, 8.4 +/- 2.1% for 8% and 9.4 +/- 1.7% at 12% inclination). This resulted from a somewhat slower increase of O2 at the onset of exercise at the highest work rate, reflected by a significantly higher time constant for O2 at 8 and 12% (24.6 +/- 7.3 s at 8% and 24.1 +/- 6.3 s at 12% versus 20.2 +/- 8.1 s at 4%). More importantly a significantly higher steady-state value for O2 was found at the highest exercise level, compared with the other exercise intensities. CONCLUSION: The higher oxygen deficit at the highest level of exercise is determined by a slower time constant and a higher asymptote value for O2.
Adult↗
Quantification of regional right and left ventricular function by ultrasonic strain rate and strain indexes after surgical repair of tetralogy of Fallot.
The quantification of regional myocardial function in tetralogy of Fallot (TOF) by conventional M-mode and 2-dimensional echocardiography is difficult because of the complex right ventricular (RV) and altered left ventricular (LV) geometry. In 30 asymptomatic postoperative TOF patients (aged 4 to 16 years) with a low pressure in the right ventricle and with varying degrees of pulmonary regurgitation and in 30 aged-matched healthy children, the ultrasonic-derived regional deformation parameters peak systolic strain rate (SR) and systolic strain (epsilon) were acquired from ventricles and compared. In TOF RV free walls, SR, and epsilon were reduced in the basal, mid-, and apical segments and averaged -1.5 +/- 0.6 second(-1) for SR and -22 +/- 8% for epsilon, respectively (p <0.001 vs normals). Peak systolic SR of the basal RV free wall correlated significantly with the QRS duration of the electrocardiogram (r = 0.81, p <0.0001). Abnormalities in RV deformation were more marked in patients with transannular patches versus infundibular patches. In the septum there was a homogeneous reduction in SR and epsilon in the basal, mid-, and apical segments. These averaged -1.4 +/- 0.3 second(-1) for SR and -19 +/- 4% for epsilon, respectively (p <0.01 vs normals). Longitudinal SR and epsilon values of the 3 LV lateral wall segments (averaged SR = -1.6 +/- 0.4 second(-1), averaged epsilon = -20 +/- 5%; p <0.05 vs normals), and radial SR and epsilon of the LV posterior wall (SR = 3.3 +/- 0.9 second(-1); epsilon = 51 +/- 14%; p <0.05 vs normals) were significantly reduced. Thus, abnormalities in regional RV and LV systolic myocardial function in asymptomatic postoperative TOF patients were quantified by the deformation parameters SR and epsilon. RV deformation abnormalities are associated with electrical depolarization abnormalities.
Adolescent↗
Acute changes in systolic and diastolic events during clinical coronary angioplasty: a comparison of regional velocity, strain rate, and strain measurement.
Ultrasound-derived natural strain rate and strain are new Doppler myocardial imaging (DMI) parameters, which can measure local deformation independently of overall heart motion and thus could better characterize local contractility than DMI velocities alone. This study was undertaken to evaluate the relative benefits of regional velocity, strain rate, and strain measurements in detecting the range of acute changes in regional myocardial function in the "at-risk" zone during coronary angioplasty. Sixty-one patients (aged 63 +/- 12, 18 women) with stable angina pectoris were studied before, at the end of, and during recovery from a 60-second percutaneous transluminal coronary angioplasty (PTCA) balloon occlusion. High frame rate (147 fps) color DMI regional velocity data were derived from basal posterior (parasternal view) and mid, apical septal (apical view) "at-risk" segments as well as from the corresponding segments in healthy subjects and analyzed offline for velocity (VEL), strain rate (SR), and strain (epsilon) measurements. Coronary occlusion resulted in the reduction in VEL(SYS), SR(SYS), and epsilon(SYS) values for both radial (RCA/CX occlusion) and longitudinal data (LAD occlusion) in all segments analyzed. Velocity parameters alone failed to distinguish between baseline and occlusive measurements in the "at-risk" segments with visually abnormal baseline function. SR(SYS) and epsilon(SYS) had a higher diagnostic accuracy (sensitivity 75%, 80% and specificity 80%, 82%, respectively) than VEL(SYS) velocity alone (sensitivity 68%, specificity 65%,) for identifying acute ischemia in either baseline normal and abnormal segments. DMI-derived indexes can identify and quantify the spectrum of acute systolic and diastolic ischemic changes induced during clinical PTCA. The quantitation of regional deformation rather than motion would appear to be more appropriate in detecting and quantifying acute ischemic changes in myocardial function, especially in segments with pre-existing abnormal function.
Adult↗
Quantification of regional left and right ventricular radial and longitudinal function in healthy children using ultrasound-based strain rate and strain imaging.
BACKGROUND: Noninvasive assessment of left (LV) and right (RV) ventricular function in children could benefit from a technique that would characterize local myocardial deformation. Color Doppler myocardial imaging (CDMI) allows the calculation of either local longitudinal or radial Strain Rate (SR) and Strain (epsilon). To determine the clinical feasibility and reproducibility of longitudinal and radial SR and epsilon, the following study was carried out. METHODS: CDMI data were obtained from 33 healthy children (4-16 years). To quantify regional longitudinal and radial function SR and epsilon data were obtained from apical and parasternal views respectively. From the extracted SR curves, peak values for systole, early diastole, and late diastole were calculated. From the extracted epsilon curves the systolic, early and late diastolic epsilon values were calculated. RESULTS: LV longitudinal deformation were homogeneous for LV basal, mid and apical segments (peak systolic SR: -1.9 +/- 0.7 s(-1), systolic epsilon -25% +/- 7%). Longitudinal SR and epsilon values were significantly higher and heterogeneous in the RV (compared with LV walls) and were maximal in the mid part of the RV free wall (peak systolic SR: -2.8 +/- 0.7 s(-1), systolic epsilon -45% +/- 13%). The RV inferior wall showed homogeneous but lower longitudinal SR and epsilon values. The LV systolic and diastolic SR and epsilon values were higher for deformation in the radial direction compared with the longitudinal direction (radial peak systolic SR: 3.7 +/- 0.9 s(-1), radial systolic epsilon 57% +/- 11%; P <.0001). The interobserver variability for radial systolic epsilon and SR was 10.3% and 13.1%, respectively. CONCLUSION: Ultrasound-based Strain SR/epsilon imaging is a practical, reproducible clinical technique, which allows the calculation of regional longitudinal and radial deformation from both LV and RV segments. The combination of regional SR/epsilon indices and the timing of specific systolic or diastolic regional events may offer a new noninvasive approach to quantifying regional myocardial function in congenital and acquired heart disease in children.
Adolescent↗
Can strain rate and strain quantify changes in regional systolic function during dobutamine infusion, B-blockade, and atrial pacing--implications for quantitative stress echocardiography.
BACKGROUND: We investigated the ability of ultrasonic strain rate (SR) and strain (epsilon) to quantify the changes in normal myocardial function at varying inotropic states and heart rates (HR) in an attempt to determine whether these new regional function indices are potentially robust enough to quantitate stress echocardiography. METHODS AND RESULTS: Twenty closed-chest pigs underwent incremental atrial pacing (AP: 120-180/min, n = 7), dobutamine infusion (DI: 2.5-20 microg/kg/min, n = 7) or esmolol infusion with subsequent pacing (EI: 0.5 +/- 0.15 mg/kg/min with pacing 120-180/min, n = 6). Radial deformation of the left ventricular posterior wall was interrogated using the parasternal short-axis view to derive regional systolic SR and epsilon values. At baseline SR and epsilon averaged 5.0 +/- 0.4 s(-1) and 60% +/- 4%, respectively. SR remained unchanged during AP and increased linearly with DI (at 2.5 microg/kg/min = 6.2 +/- 0.3 s(-1), P <.05 vs baseline; at 20 microg/kg/min = 9.9 +/- 0.7 s(-1), P <.0001 vs baseline), whereas EI resulted in a constant decrease of 30% +/- 4% in SR (P <.05). SR and left ventricular dP/dt(MAX) correlated linearly over the induced change in inotropic states and HR (r = 0.82; P <.0001). Conversely, epsilon values decreased during AP (at 180/min = 36% +/- 2%, P <.001). During DI, epsilon initially increased at 2.5 and 5 microg/kg/min (at 5 microg/kg/min = 77% +/- 6%, P <.05) and decreased for higher doses because of increasing HR. EI resulted in a decrease of 30% +/- 4% in epsilon with a further decrease during subsequent pacing. epsilon correlated linearly with left ventricular ejection fraction (r = 0.87; P <.0001). CONCLUSION: Both SR and epsilon can quantify the changes in myocardial function during a range of inotropic challenges and over the range of physiologic HRs encountered during clinical stress echocardiography. SR may reflect regional contractile function, whereas epsilon reflects changes in ventricular geometry. This study would suggest that for quantitative stress echocardiography SR is better in quantification of changes in contractile function being relatively independent of HR.
Adrenergic beta-Antagonists↗
Can changes in systolic longitudinal deformation quantify regional myocardial function after an acute infarction? An ultrasonic strain rate and strain study.
OBJECTIVES: The aim of this study was to evaluate the additional value of ultrasonic strain rate and strain to myocardial velocity in the identification and quantification of regional asynergy after an acute myocardial infarction (MI). METHODS: Forty patients (59 +/- 13 years) were investigated 3 +/- 2 days after a first infarction and compared with 14 age-matched controls with normally contracting segments (group A, n = 146). Longitudinal myocardial velocities, strain rate (SR) and strain (epsilon) were postprocessed from basal, mid, and apical segments interrogated using apical views. In a subset of patients with coronary angiograms (n = 24), myocardial segments were divided into 3 groups: normally contracting segments supplied by a normal coronary artery (group B1), normally contracting segments supplied by a diseased coronary artery (group B2), and segments with abnormal motion (group B3). Velocities were decreased in patients with myocardial infarction (MI) (P <.05 vs controls) but failed to accurately differentiate normally from abnormally contracting segments. At the opposite end, systolic SR and epsilon decreased significantly with segmental asynergy severity and could identify infarct-involved segments (group B3) with a sensitivity/specificity of 85% (systolic SR and epsilon cutoff values of -0.8 s(-1) and -13%, respectively). CONCLUSION: Strain rate and strain can better assess segmental dysfunction severity than myocardial velocities alone after an acute MI.
Aged↗
Doppler tissue velocity, strain, and strain rate imaging with transesophageal echocardiography in the operating room: a feasibility study.
OBJECTIVE: Transesophageal echocardiography (TEE) is increasingly used to monitor regional myocardial function during cardiac operation. Doppler myocardial imaging (DMI) indices can potentially provide new information on regional radial and longitudinal myocardial motion and local deformation. This study examined the feasibility of TEE acquisition of regional radial and longitudinal velocity, displacement (D), strain, and strain rate data during cardiac operation and evaluated the effects of sternotomy and pericardial opening on these indices. METHODS: After a baseline transthoracic echocardiographic study, TEE was performed in 22 patients (age 64 +/- 7 years) before sternotomy, after sternotomy with intact pericardium, and after pericardial opening. Regional DMI velocity analysis was performed for the transgastric anterior and inferior walls midpapillary segment (radial function) and the 4-chamber septum and 2-chamber inferior walls basal, mid, and apical segments (longitudinal function). For each segment, systolic and diastolic velocity were derived and D, strain, and strain rate calculated. RESULTS: Transthoracic echocardiographic study and TEE provided similar data from an equivalent number of interpretable segments. In the basal and mid septum, maximum longitudinal systolic D decreased with pericardial opening (basal septum pericardium closed: 6.6 +/- 1.5 mm, open: 4.6 +/- 1.8 mm, P =.007; midseptum pericardium closed: 4.7 +/- 2.5 mm, open: 2.7 +/- 1.5 mm, P =.028). No changes were evident in systolic or diastolic DMI indices in all other segments. CONCLUSION: DMI with TEE is feasible during cardiac operation. During pericardial opening, longitudinal D decreases in the septum, but not in the inferior wall. DMI requires further evaluation in the assessment of ventricular function and the detection of ischemia in the operating room.
Aged↗
Two-dimensional ultrasonic strain rate measurement of the human heart in vivo.
A study is presented in which the feasibility of two-dimensional strain rate estimation of the human heart in vivo has been demonstrated. To do this, ultrasonic B-mode data were captured at a high temporal resolution of 3.8 ms and processed off-line. The motion of the RF signal patterns within the two-dimensional sector image was tracked and used as the basis for strain rate estimation. Both axial and lateral motion and strain rate estimates showed a good agreement with the results obtained by more established, one-dimensional techniques.
Adult↗
Echocardiographic strain and strain-rate imaging: a new tool to study regional myocardial function.
Ultrasonic imaging is the noninvasive clinical imaging modality of choice for diagnosing heart disease. At present, two-dimensional ultrasonic grayscale images provide a relatively cheap, fast, bedside method to study the morphology of the heart. Several methods have been proposed to assess myocardial function. These have been based on either grayscale or motion (velocity) information measured in real-time. However, the quantitative assessment of regional myocardial function remains an important goal in clinical cardiology. To do this, ultrasonic strain and strain-rate imaging have been introduced. In the clinical setting, these techniques currently only allow one component of the true three-dimensional deformation to be measured. Clinical, multidimensional strain (rate) information can currently thus only be obtained by combining data acquired using different transducer positions. Nevertheless, given the appropriate postprocessing, the clinical value of these techniques has already been shown. Moreover, multidimensional strain and strain-rate estimation of the heart in vivo by means of a single ultrasound acquisition has been shown to be feasible. In this paper, the new techniques of ultrasonic strain rate and strain imaging of the heart are reviewed in terms of definitions, data acquisition, strain-rate estimation, postprocessing, and parameter extraction. Their clinical validation and relevance will be discussed using clinical examples on relevant cardiac pathology. Based on these examples, suggestions are made for future developments of these techniques.
Echocardiography↗
Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate.
For porcine myocardium, ultrasonic regional deformation parameters, systolic strain (epsilon(sys)) and peak systolic strain rate (SR(sys)), were compared with stroke volume (SV) and contractility [contractility index (CI)] measured as the ratio of end-systolic strain to end-systolic wall stress. Heart rate (HR) and contractility were varied by atrial pacing (AP = 120-180 beats/min, n = 7), incremental dobutamine infusion (DI = 2.5-20 microg. kg(-1). min(-1), n = 7), or continuous esmolol infusion (0.5 mg. kg(-1). min(-1)) + subsequent pacing (120-180 beats/min) (EI group, n = 6). Baseline SR(sys) and epsilon(sys) averaged 5.0 +/- 0.4 s(-1) and 60 +/- 4%. SR(sys) and CI increased linearly with DI (20 microg. kg(-1). min(-1); SR(sys) = 9.9 +/- 0.7 s(-1), P < 0.0001) and decreased with EI (SR(sys) = 3.4 +/- 0.1 s(-1), P < 0.01). During pacing, SR(sys) and CI remained unchanged in the AP and EI groups. During DI, epsilon(sys) and SV initially increased (5 microg. kg(-1). min(-1); epsilon(sys) = 77 +/- 6%, P < 0.01) and then progressively returned to baseline. During EI, SV and epsilon(sys) decreased (epsilon(sys) = 38 +/- 2%, P < 0.001). Pacing also decreased SV and epsilon(sys) in the AP (180 beats/min; epsilon(sys) = 36 +/- 2%, P < 0.001) and EI groups (180 beats/min; epsilon(sys) = 25 +/- 3%, P < 0.001). Thus, for normal myocardium, SR(sys) reflects regional contractile function (being relatively independent of HR), whereas epsilon(sys) reflects changes in SV.
Adrenergic beta-Antagonists↗
Tissue Doppler Echocardiography: Historical Perspective and Technological Considerations.
Tissue Doppler echocardiography is a new ultrasonographic approach to the quantification of myocardial function. It is based on the interrogation of the high amplitude, low velocity reflected ultrasound signals from the myocardium. Velocity data can be obtained during pulsed- or color Doppler methodologies. Color Doppler data can be processed to determine regional acceleration, strain, strain rate, delay, and amplitude of motion. Color myocardial Doppler frame rates of up to 200 s(-1) can be implemented by parallel processing of the data, thus overcoming the early temporal resolution limitations of the technique.
Journal Article↗
Values for Mitral Valve Annulus Dimensions in Normals and Patients with Mitral Regurgitation.
OBJECTIVES: The present study was designed to investigate the dimensions of mitral valve annulus in the presence of mitral regurgitation. METHOD: Fifty-four patients were examined. On transthoracic echocardiographic images, we performed linear measurements in the parasternal plane in order to define the size of the left ventricle, left atrium, and mitral valve annulus. We compared these findings with those obtained in 16 control subjects. RESULTS: Twenty-one patients with mild or moderate mitral regurgitation demonstrated no significant change of the mitral valve annulus compared with the control group (P > 0.05). Seventeen patients with severe mitral regurgitation (grade of 4) had a significant increase of the dimensions of the mitral valve annulus, left ventricle, and left atrium (P < 0.05). The etiology of mitral regurgitation was degenerative in 32 patients, rheumatic in 2 patients, and mitral valve prolapse in 4 patients. All patients had normal left ventricular systolic function. Thirty-one patients were in normal sinus rhythm, and seven were in atrial fibrillation. CONCLUSIONS: The measurement of the diameter of the mitral valve annulus is feasible with transthoracic echocardiography. In addition to the evaluation of mitral valve leaflets and subvalvular apparatus, the measurement of the mitral valve annulus is important in the evaluation of mitral regurgitation, as its enlargement is indicative for severe mitral regurgitation.
Journal Article↗