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Influence of chest conformation on myocardial strain parameters in healthy subjects with mitral valve prolapse

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Abstract

Chest shape might affect myocardial strain parameters. However, the relationship between myocardial strain parameters and chest conformation has not been previously investigated in subjects with mitral valve prolapse (MVP). Between April 2019 and May 2020, 60 healthy subjects (50.1 ± 8.6 year/old, 46.6% females) with MVP and mild-to-moderate mitral regurgitation, and 60 controls matched by age, sex, and cardiovascular risk factors were consecutively studied. Participants underwent modified Haller index (MHI) assessment (ratio of chest transverse diameter over the distance between sternum and spine), and transthoracic echocardiography implemented with 2D-speckle tracking analysis. MHI was significantly greater in MVP group than controls (2.6 ± 0.35 vs 2.1 ± 0.23, p < 0.0001). Left ventricular (LV) ejection fraction was similar in MVP and controls (63.5 ± 3.7% vs 64.3 ± 3.9%, p = 0.25). LV regional and global longitudinal (GLS), circumferential (GCS) and radial strain (GRS) parameters and LV peak twist were all significantly lower in MVP compared to controls (all p < 0.0001). MVP subjects with a tight chest (MHI > 2.5, n = 30), and those with MHI ≤ 2.5 (n = 30) were then separately analyzed. A significant impairment in myocardial strain parameters and LV peak twist was documented in MVP subjects with MHI > 2.5, but not in those with MHI ≤ 2.5. MHI showed a strong inverse correlation with LV-GLS (r = − 0.85), GCS (r = − 0.84), GRS (r = − 0.84) and LV peak twist (r = − 0.94). In MVP subjects, impairment of myocardial strain parameters is not due to intrinsic reduction of cardiac contractility function, but it appears to be related to the degree of chest deformity.

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Abbreviations

2D:

Two-dimensional

AFI:

Automated function imaging

A-P:

Antero-posterior

AVC:

Aortic valve closure

BP:

Blood pressure

BSA:

Body surface area

CI:

Confidence interval

CMR:

Cardiovascular magnetic resonance

DBP:

Diastolic blood pressure

ECG:

Electrocardiogram

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

HR:

Heart rate

ICC:

Intraclass correlation coefficient

LAVi:

Left atrial volume index

LBBB:

Left bundle branch block

L-L:

Latero-lateral

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

LVFP:

Left ventricular filling pressures

LVMi:

Left ventricular mass index

MHI:

Modified Haller index

MVP:

Mitral valve prolapse

MR:

Mitral regurgitation

NS-STT:

Nonspecific ST-segment and T-wave abnormalities

PE:

Pectus excavatum

RBBB:

Right bundle branch block

ROI:

Region of interest

RV:

Right ventricular

RVEDD:

Right ventricular end-diastolic diameter

RWT:

Relative wall thickness

SBP:

Systolic blood pressure

SPAP:

Systolic pulmonary artery pressure

SR:

Strain rate

STE:

Speckle-tracking echocardiography

TAPSE:

Tricuspid annular plane systolic excursion

TTE:

Transthoracic echocardiography

VPB:

Ventricular premature beats

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Acknowledgement

This work has been supported by Italian Ministry of Health Ricerca Corrente—IRCCS MultiMedica.

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Authors and Affiliations

  1. Department of Cardiology, Ospedale San Giuseppe MultiMedica, Milan, Italy

    Andrea Sonaglioni, Michele Lombardo & Gian Franco Gensini

  2. Department of Cardiology, Policlinico San Giorgio, Pordenone, Italy

    Gian Luigi Nicolosi

  3. Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria “S. Maria della Misericordia”, Perugia, Italy

    Giuseppe Ambrosio

  4. Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy

    Andrea Sonaglioni

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  1. Andrea Sonaglioni
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  2. Gian Luigi Nicolosi
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Correspondence to Andrea Sonaglioni.

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Sonaglioni, A., Nicolosi, G.L., Lombardo, M. et al. Influence of chest conformation on myocardial strain parameters in healthy subjects with mitral valve prolapse. Int J Cardiovasc Imaging 37, 1009–1022 (2021). https://doi.org/10.1007/s10554-020-02085-z

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