PMID- 29391146 OWN - NLM STAT- MEDLINE DCOM- 20190528 LR - 20190528 IS - 1552-6259 (Electronic) IS - 0003-4975 (Print) IS - 0003-4975 (Linking) VI - 105 IP - 6 DP - 2018 Jun TI - Ischemic Mitral Regurgitation: Abnormal Strain Overestimates Nonviable Myocardium. PG - 1754-1761 LID - S0003-4975(18)30062-6 [pii] LID - 10.1016/j.athoracsur.2018.01.005 [doi] AB - BACKGROUND: Therapy for moderate ischemic mitral regurgitation remains unclear. Determination of myocardial viability, a necessary prerequisite for an improvement in regional contractility, is a likely key factor in determining response to revascularization alone. Myocardial strain has been proposed as a viability measure but has not been compared with late gadolinium enhancement (LGE) cardiac magnetic resonance imaging. We hypothesized that abnormal strain overestimates nonviable left ventricular (LV) segments measured with LGE and that ischemia and mechanical tethering by adjacent transmural myocardial infarction (TMI) also decreases strain in viable segments. METHODS: Sixteen patients with mild or greater ischemic mitral regurgitation and 7 healthy volunteers underwent cardiac magnetic resonance imaging with noninvasive tags (complementary spatial modulation of magnetization [CSPAMM]), LGE, and stress perfusion. CSPAMM images were post-processed with harmonic phase and circumferential and longitudinal strains were calculated. Viability was defined as the absence of TMI on LGE (hyperenhancement >50% of wall thickness). The borderzone was defined as any segment bordering TMI. Abnormal strain thresholds (+/-1 to 2.5 SDs from normal mean) were compared with TMI, ischemia, and borderzone. RESULTS: 7.4% of LV segments had TMI on LGE, and more than 14.5% of LV segments were nonviable by strain thresholds (p < 0.005). In viable segments, ischemia impaired longitudinal strain (least perfused one-third of LV segments: -0.18 +/- 0.08 versus most perfused: -0.22 +/- 0.1, p = 0.01) and circumferential strain (-0.12 +/- 0.1 versus -0.16 +/- 0.08, p < 0.05). In addition, infarct proximity impaired longitudinal strain (-0.16 +/- 0.11 borderzone versus -0.18 +/- 0.09 remote, p = 0.05). CONCLUSIONS: Impaired LV strain overestimates nonviable myocardium compared with TMI on LGE. Ischemia and infarct proximity also decrease strain in viable segments. CI - Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. FAU - Morgan, Ashley E AU - Morgan AE AD - East Bay Surgical Residency, University of California, San Francisco, California. FAU - Zhang, Yue AU - Zhang Y AD - Surgical Service, Veterans Affairs Medical Center, San Francisco, California. FAU - Tartibi, Mehrzad AU - Tartibi M AD - Surgical Service, Veterans Affairs Medical Center, San Francisco, California. FAU - Goldburg, Samantha AU - Goldburg S AD - Department of Medicine (Cardiology), Weill Cornell Medical College, New York, New York. FAU - Kim, Jiwon J AU - Kim JJ AD - Department of Medicine (Cardiology), Weill Cornell Medical College, New York, New York. FAU - Nguyen, Thanh D AU - Nguyen TD AD - Department of Radiology, Weill Cornell Medical College, New York, New York. FAU - Guccione, Julius AU - Guccione J AD - Department of Bioengineering, University of California, San Francisco, California; Surgical Service, Veterans Affairs Medical Center, San Francisco, California; Department of Surgery, University of California, San Francisco, California. FAU - Ge, Liang AU - Ge L AD - Department of Bioengineering, University of California, San Francisco, California; Surgical Service, Veterans Affairs Medical Center, San Francisco, California; Department of Surgery, University of California, San Francisco, California. FAU - Weinsaft, Jonathan W AU - Weinsaft JW AD - Department of Medicine (Cardiology), Weill Cornell Medical College, New York, New York. FAU - Ratcliffe, Mark B AU - Ratcliffe MB AD - Department of Bioengineering, University of California, San Francisco, California; Surgical Service, Veterans Affairs Medical Center, San Francisco, California; Department of Surgery, University of California, San Francisco, California. Electronic address: mark.ratcliffe@va.gov. LA - eng GR - K23 HL140092/HL/NHLBI NIH HHS/United States GR - R01 HL063348/HL/NHLBI NIH HHS/United States GR - R01 HL128278/HL/NHLBI NIH HHS/United States PT - Comparative Study PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20180131 PL - Netherlands TA - Ann Thorac Surg JT - The Annals of thoracic surgery JID - 15030100R SB - IM CIN - Ann Thorac Surg. 2018 Jun;105(6):1761-1762. PMID: 29501661 CIN - J Thorac Dis. 2018 Nov;10(Suppl 33):S3946-S3950. PMID: 30631523 CIN - J Thorac Dis. 2018 Nov;10(Suppl 33):S4073-S4075. PMID: 30631558 MH - Aged MH - Case-Control Studies MH - Coronary Artery Disease/diagnostic imaging/physiopathology/surgery MH - Female MH - Follow-Up Studies MH - Humans MH - Magnetic Resonance Imaging, Cine/*methods MH - Male MH - Middle Aged MH - Mitral Valve Insufficiency/*diagnostic imaging/physiopathology/surgery MH - Myocardial Infarction/*diagnostic imaging/physiopathology/surgery MH - Myocardial Ischemia/diagnostic imaging/physiopathology/surgery MH - Myocardial Revascularization/*methods MH - Reference Values MH - Risk Assessment MH - Severity of Illness Index PMC - PMC6005393 MID - NIHMS974356 EDAT- 2018/02/03 06:00 MHDA- 2019/05/29 06:00 PMCR- 2018/06/18 CRDT- 2018/02/03 06:00 PHST- 2017/06/25 00:00 [received] PHST- 2017/11/28 00:00 [revised] PHST- 2018/01/03 00:00 [accepted] PHST- 2018/02/03 06:00 [pubmed] PHST- 2019/05/29 06:00 [medline] PHST- 2018/02/03 06:00 [entrez] PHST- 2018/06/18 00:00 [pmc-release] AID - S0003-4975(18)30062-6 [pii] AID - 10.1016/j.athoracsur.2018.01.005 [doi] PST - ppublish SO - Ann Thorac Surg. 2018 Jun;105(6):1754-1761. doi: 10.1016/j.athoracsur.2018.01.005. Epub 2018 Jan 31.