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Ventriculoarterial coupling and myocardial deformation parameters in patients with functional mitral regurgitation and normal controls: a cardiac magnetic resonance study
The ventriculoarterial coupling (VAC) ratio, the ratio of arterial and ventricular elastance, is a measure of cardiovascular efficiency, and can be estimated non-invasively as the ratio of end-systolic volume to stroke volume. Little is known about the potential relationship between VAC and myocardial deformation. We used a previously-described cardiac magnetic resonance (CMR) method to assess VAC in a cohort of patients with functional mitral regurgitation (FMR), examined its relation to myocardial deformation variables, and compared with controls.
To calculate VAC and myocardial deformation variables in a cohort of patients with FMR, as compared with normal controls, using CMR, and assess for correlation.
Methods We analysed CMR data from a cohort of patients with FMR with a mitral regurgitation fraction >10% (n=41), as well as controls with normal cardiac anatomy and function (n=49). All subjects underwent CMR studies for clinical indications. 2D myocardial-tracking analyses were conducted using commercially available software. We calculated VAC (end-systolic volume/stroke volume), peak apical displacement (PAD), peak basal displacement (PBD), global longitudinal strain (GLS), longitudinal displacement (GLD) and ventricular twist.
Results The median age of the control cohort was 42.5 years, range 16-78 years, and 63% were male. The median age of the FMR cohort was 57 years old, range 23-84 years, and 66% were male (p=0.0005 for age). Patients with FMR had significantly increased median VAC as compared to controls (1.85 vs 0.59, p<0.0001, figure A), with a "dose-dependent" increase in VAC observed with increasing regurgitation fraction (p=0.0145, R²=0.144, figure B). Twist, GLD and GLS correlated negatively with VAC in the FMR cohort, with GLS showing the strongest correlation (p<0.0001, R²=0.59, figure C), but only GLS correlated with VAC in the control cohort. There was no significant correlation between VAC and PAD or PBD, and there was no significant correlation between VAC and age.
Conclusion Although the control cohort was significantly younger, the absence of a correlation between VAC and age in this study suggest that the results should not be affected by this. We found that patients with FMR demonstrate cardiovascular inefficiency as evidenced by increased VAC ratio and this correlates with myocardial deformation parameters, in particular GLS. We found a relationship between GLS and VAC in both FMR and control subjects. Further study into the relationship between these parameters is warranted, in particular to assess the possible prognostic implications.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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