Purpose: Cardiac resynchronization therapy (CRT) has a positive effect on the improvement of functional mitral regurgitation in patients with heart failure with reduced ejection fraction. However geometric changes in the mitral valve apparatus, subvalvular structures and their contribution to the improvement of mitral regurgitation after CRT have not been clearly defined. The aim of our study was to evaluate the geometric parameters of mitral valve apparatus measured with 3Dimensional (3D) transesophageal echocardiography (TEE) before CRT implantation and to determine the parameters predicting the improvement of mitral regurgitation after CRT. Methods: In this prospective study thirty patients with moderate or severe mitral regurgitation with low EF heart failure planned for CRT implantation and had an indication for TEE were included. Effective regurgitant orifice (ERO) and regurgitant volume (RV) measurements were performed before CRT implantation. Detailed quantitative measurements of mitral valve were done from recorded images by 3D TEE. ERO, RV measurements were repeated to evaluate mitral regurgitation at the end of 3rd month. Results: There were no significant changes in left ventricular EF and left ventricular diameters at third month follow-up, whereas ERO and RV values were decreased. posterior leaflet angle was found higher in non-responder group compared to responder group. (28,93 ± 8,41 vs 41,25 ± 10,90, p = 0,006). Conclusion: Heart failure patients with moderate or severe functional mitral regurgitation who underwent CRT implantation were found lower posterior leaflet angle which was measured by 3D TEE in the patient group whose mitral regurgitation improved after CRT.

Purpose: An elevated left ventricular (LV) filling pressure is the main finding in patients with heart failure with preserved ejection fraction, which is estimated with an algorithm using echocardiographic parameters recommended by the recent American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guideline. In this study, we sought to determine the efficacy of LV global longitudinal strain (GLS) to estimate the elevated LV filling pressure. Methods and Results: 73 prospectively selected patients undergoing left ventricular catheterization (mean age 63.19±9.64, 68.5% male) participated in this study. Using the algorithm, the LV filling pressure was estimated with the echo parameters obtained within 24hrs before the catheterization. The LV GLS was measured using the automated functional imaging system (GE, Vivid E9 USA). Invasive LV pre-A pressure corresponding to mean left atrial pressure (LAP) was used as a reference, and >12 mm Hg was defined as elevated. The invasive LV filling pressure was elevated in 43 (58.9%) and normal in 30 patients (41.1%). In 9 (12.3%) patients of 73 are defined as indeterminate based on the 2016 algorithm. Using the ROC method, -18.1% of LV GLS estimated the LV filling pressure (AUC=0.79, 73% specificity, 84% sensitivity) with higher sensitivity compared with the algorithm (AUC=0.76, 77% specificity, 72% sensitivity). Conclusions: We confirmed that the LV GLS is feasible and reproducible in estimating LV filling pressure. In addition, LV GLS highly predicts elevated LAP as E/e’ and TR jet velocity and may be used as major criteria for the diagnosis of HFpEF

Rheumatic mitral stenosis is a leading cause of morbidity in developing countries. Symptomatic patients with mitral valve area>1.5 cm2 comprises a gray zone in management. Exercise stress testing is recommended in these patients with symptoms discordant with the severity of the stenosis. Left atrial strain analysis with speckle tracking imaging emerges as a promising technique for the evaluation of haemodynamics better. The aim of our study is to examine the left atrial and ventricular function both during rest and just after exercise by speckle tracking imaging in patients with mild rheumatic mitral stenosis and ascertain early hemodynamic deterioration. We included 46 patients with mild mitral stenosis (mitral valve area>1.5 cm2) The patients were evaluated with comprehensive 2D and Doppler echocardiography during rest, before the exercise stress test. Left atrial and ventricular peak systolic strain values were calculated by using a software program. Exercise stress test was then performed by using treadmill with standard Bruce protocol. Immediately after the termination of the test, the echocardiographic examination was repeated. Both mean trans-mitral gradient and systolic pulmonary artery pressure values were higher following exercise (p<0.001, p=0.001, respectively). Exercise did not cause a significant chance in left atrial and ventricular peak systolic strain value (p=0.708, p=0.854). A negative significant correlation was found between the mean trans-mitral gradient and peak systolic left atrial strain following exercise. In patients with mitral valve area>1.5 cm2, exercise stress test did not cause a significant change in left atrial and ventricular peak systolic strain.