Myocardial Deformation Imaging on Exercise in Chronic Primary Mitral Regurgitation

  • Rachel Argyle

Student thesis: Doctor of Medicine


Background: Accurate assessment of left ventricular (LV) systolic function in chronic severe primary mitral regurgitation (MR) is important as the aim is to consider surgical repair prior to the onset of irreversible LV dysfunction. However this can be difficult to judge as conventional measures of LV function (such as ejection fraction, EF) may remain normal despite impaired LV contractility due to the increased preload of the condition. Advanced echocardiographic techniques, including deformation imaging, appear promising as they are less load dependent. As the earliest symptoms in severe MR are usually exertional, this study aimed to assess markers of LV deformation on exercise in patients with normal resting EF in order to try and identify the earliest signs of LV decompensation.Methods: Transthoracic echocardiography was carried out at rest and on submaximal supine exercise in asymptomatic patients with moderate to severe chronic primary MR and matched controls. Conventional contractile reserve (CR) as measured by EF change on exercise was used to subdivide patients into those with preserved (CR+) and abnormal (CR-) LV function. Myocardial strain and twist were assessed using the speckle tracking technique.Results: MR patients failed to show the normal enhancement in systolic twist on exercise. The onset and peak of untwisting were delayed in MR at rest and normalised on exercise in CR+ but not in CR-. Abnormalities in twist on exercise worsened with increasing resting preload. Longitudinal strain tended to increase normally on exercise in CR+ but not in CR-. Systolic longitudinal strain rate correlated with twist at rest and on exercise, whereas diastolic strain rate correlated with the timing of untwisting on exercise.Conclusion: Abnormalities in myocardial deformation are seen at rest and on exercise in patients with severe MR, particularly in those with decompensated LV function. This may contribute to the development of functional impairment with progressive disease.
Date of Award31 Dec 2012
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSimon Ray (Supervisor) & David Eisner (Supervisor)


  • Exercise
  • Strain
  • Myocardial Deformation
  • Mitral Regurgitation
  • Torsion

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