Lymphedema Is Associated with Mitral Annular Abnormalities-A Three-Dimensional Speckle-Tracking Echocardiographic Analysis from the MAGYAR-Path Study.

Abstract

Introduction: Lymphedema is a chronic, progressive disorder characterized by the excessive accumulation of lymphatic fluid within the interstitial compartment resulting from impaired lymphatic transport. Consequently, the primary aim of the present study was to evaluate three-dimensional speckle-tracking echocardiography (3DSTE)-derived mitral annular (MA) morphology and function in patients with lymphedema, and to compare these parameters with those of age- and sex-matched healthy controls. Associations between MA parameters and regional LV strains were also assessed. Furthermore, it was investigated whether one-hour use of medical compression stockings (MCSs) exerts acute effects on MA geometry and function and regional LV strains in lymphedema. Methods: The study included 24 patients with lymphedema (mean age: 48.0 ± 11.2 years, 23 females) without known cardiovascular symptoms. Their results were compared to those of 45 healthy individuals (mean age: 42.1 ± 13.9 years, all females) with a similar mean age value and gender ratio. Patients and controls had no traditional cardiovascular risk factors. All patients and control subjects underwent conventional M-mode and two-dimensional Doppler echocardiography extended with 3DSTE. Results: At rest, radial and circumferential strains (LV-RS and LV-CS, respectively) tended to increase across most LV regions, except for basal LV-RS. Conversely, longitudinal contraction, represented by LV longitudinal strain (LV-LS) was reduced in the basal LV region but tended to increase in the midventricular and apical regions. This distinct contractile pattern was accompanied by reduced end-diastolic MA dimensions, whereas end-systolic parameters remained unchanged, consequently leading to impaired MA sphincter-like function. While most regional LV strains shifted toward control values following MCS use-except for basal and apical LV-RS and midventricular and apical LV-LS-end-diastolic MA dimensions simultaneously demonstrated a similar trend, culminating in an improvement in MA functional properties. Conclusions: The presented exploratory findings suggest that lymphedema may be associated with alterations in end-diastolic MA dimensions and a consequent impairment of MA function, which appear to be accompanied by specific regional LV functional abnormalities. Furthermore, one-hour MCS use was observed to exert acute, directional shifts in these imaging-derived surrogate parameters.