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Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy.

Abstract

OBJECTIVES

The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels.

METHODS

The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay.

RESULTS

The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6 months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group.

CONCLUSIONS

The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction.

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  • Authors+Show Affiliations

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan. shingu@huhp.hokudai.ac.jp.

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    ,

    Emergency and Clinical Care Center, Hokkaido University Hospital, Sapporo, Japan.

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    ,

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31230181

    Citation

    Ishigaki, Takahiro, et al. "Perioperative Changes of the Slope in the Preload Recruitable Stroke Work Relationship By a Single-beat Technique After Mitral Valve Surgery in Functional Mitral Regurgitation With Non-ischemic Dilated Cardiomyopathy." General Thoracic and Cardiovascular Surgery, 2019.
    Ishigaki T, Shingu Y, Katoh N, et al. Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy. Gen Thorac Cardiovasc Surg. 2019.
    Ishigaki, T., Shingu, Y., Katoh, N., Wakasa, S., Katoh, H., Ooka, T., ... Matsui, Y. (2019). Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy. General Thoracic and Cardiovascular Surgery, doi:10.1007/s11748-019-01164-w.
    Ishigaki T, et al. Perioperative Changes of the Slope in the Preload Recruitable Stroke Work Relationship By a Single-beat Technique After Mitral Valve Surgery in Functional Mitral Regurgitation With Non-ischemic Dilated Cardiomyopathy. Gen Thorac Cardiovasc Surg. 2019 Jun 22; PubMed PMID: 31230181.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Perioperative changes of the slope in the preload recruitable stroke work relationship by a single-beat technique after mitral valve surgery in functional mitral regurgitation with non-ischemic dilated cardiomyopathy. AU - Ishigaki,Takahiro, AU - Shingu,Yasushige, AU - Katoh,Nobuyasu, AU - Wakasa,Satoru, AU - Katoh,Hiroki, AU - Ooka,Tomonori, AU - Kubota,Suguru, AU - Matsui,Yoshiro, Y1 - 2019/06/22/ PY - 2019/03/20/received PY - 2019/06/16/accepted PY - 2019/6/24/entrez PY - 2019/6/24/pubmed PY - 2019/6/24/medline KW - Dilated cardiomyopathy KW - Mitral regurgitation KW - Preload recruitable stroke work relationship JF - General thoracic and cardiovascular surgery JO - Gen Thorac Cardiovasc Surg N2 - OBJECTIVES: The slope in the preload recruitable stroke work relationship is a highly linear, load-insensitive contractile parameter. However, the perioperative change of the slope has not been reported before. We examined the perioperative slope from a steady-state single beat in patients with functional mitral regurgitation and assessed the correlation with brain natriuretic peptide (BNP) levels. METHODS: The study included 16 patients with non-ischemic dilated cardiomyopathy and refractory heart failure: 10 patients underwent mitral valve plasty and left ventricular plasty (MVP + LVP group) and 6 patients who underwent mitral valve replacement and papillary muscle tugging approximation (MVR + PMTA group). The left ventricular ejection fraction was assessed by the modified Simpson method; the slope was assessed by the single-beat technique using transthoracic echocardiography. BNP levels were measured by chemiluminescent immunoassay. RESULTS: The left ventricular ejection fraction and slope did not significantly change from pre- to early post-surgery in the MVP + LVP group. Both the left ventricular ejection fraction and slope significantly increased 6 months after surgery in the MVR + PMTA group. Postoperative BNP level was low in the MVR + PMTA group. While the postoperative left ventricular ejection fraction did not correlate with BNP levels, the postoperative slope significantly correlated with BNP level after surgery in the MVP + LVP group and in the total functional mitral regurgitation group. CONCLUSIONS: The change of slope was dependent on surgical procedures. In functional mitral regurgitation, the slope may be a more sensitive parameter in reflecting the left ventricular contractile function than the left ventricular ejection fraction. SN - 1863-6713 UR - https://www.unboundmedicine.com/medline/citation/31230181/Perioperative_changes_of_the_slope_in_the_preload_recruitable_stroke_work_relationship_by_a_single-beat_technique_after_mitral_valve_surgery_in_functional_mitral_regurgitation_with_non-ischemic_dilated_cardiomyopathy L2 - https://dx.doi.org/10.1007/s11748-019-01164-w DB - PRIME DP - Unbound Medicine ER -