Left ventricular longitudinal strain is associated with mitral annular fractional area change in healthy subjects—Results from the three-dimensional speckle tracking echocardiographic MAGYAR-Healthy Study

Zsolt Kovács, Árpád Kormányos, Péter Domsik, Anita Kalapos, Csaba Lengyel, Nóra Ambrus, Zénó Ajtay, Györgyike Á. Piros, Tamás Forster, Attila Nemes


Background: The mitral annulus (MA) plays a significant role in promoting left atrial and left ventricular (LV) filling and emptying, which is dependent on LV functional properties. The present study aimed to investigate the relationship between LV strains, quantitative features of longitudinal contractility and MA size and function in healthy subjects.
Methods: The present study comprised 295 healthy adults; 117 subjects were excluded due to inferior image quality (40%). Finally, 178 healthy adults (mean age: 32.0±11.3 years, 92 males). Complete two-dimensional Doppler echocardiography and three-dimensional speckle-tracking echocardiography were performed in all cases.
Results: The global and mean segmental left ventricular longitudinal strain (LV-LS) proved to be −16.1%±2.5% and −16.9%±2.4%, respectively. In the present study, LV-LS ≤−13% was considered to be reduced. In ROC analysis, the cut-off value for MA fractional area change (MAFAC) to predict impaired LV-LS was ≤44%, with 67% sensitivity and 69% specificity and ROC area under curve 0.73 (P=0.0005). Significantly increased LV volumes and LV mass and reduced MAFAC could be demonstrated in healthy subjects with global LV-LS ≤−13%. Significantly larger ratio of subjects with global LV-LS ≤−13% had MAFAC ≤44% (31% vs. 67%, P=0.009). Patients with MAFAC ≤44% had significantly reduced global and mean segmental LV-LS. Significantly larger ratio of subjects with MAFAC ≤44% had global LV-LS ≤−13% (4% vs. 16%, P=0.009).
Conclusions: There is a strong relationship between MA and LV longitudinal function. MA fractional area change predicts global LV-LS.