(Circulation. 2000;102:1400.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Determinants of the Degree of Functional Mitral Regurgitation in Patients With Systolic Left Ventricular Dysfunction
A Quantitative Clinical Study
From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn.
Background—Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered.
Methods and Results—In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50%, mean 31±9%) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15±14 mm2, 0 to 87 mm2) was observed, unrelated to ejection fraction (P=0.32). The major determinant of ERO was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P<0.0001) and multivariate (both P<0.0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P<0.0001), independent of LV volumes, function, and sphericity.
Conclusions—The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.
Key Words: echocardiography • heart failure • ventricles • mitral valve • regurgitation
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|
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|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
J.K. Oh Echocardiography in heart failure: Beyond diagnosis Eur J Echocardiogr, January 1, 2007; 8(1): 4 - 14. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
 D. Aronson, N. Goldsher, R. Zukermann, M. Kapeliovich, J. Lessick, D. Mutlak, S. Dabbah, W. Markiewicz, R. Beyar, H. Hammerman, et al. Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction Arch Intern Med, November 27, 2006; 166(21): 2362 - 2368. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
M. A. Acker, S. Bolling, R. Shemin, J. Kirklin, J. K. Oh, D. L. Mann, M. Jessup, H. N. Sabbah, R. C. Starling, S. H. Kubo, et al. Mitral valve surgery in heart failure: Insights from the Acorn Clinical Trial. J. Thorac. Cardiovasc. Surg., September 1, 2006; 132(3): 568 - 577.e4. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al. ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., August 1, 2006; 48(3): 598 - 675. [Full Text] [PDF]
|
|
|
|
|
|
P-V Ennezat, B Gal, C Kouakam, C Marquie, T LeTourneau, D Klug, D Lacroix, D Logeart, A Cohen-Solal, S Dennetiere, et al. Cardiac resynchronisation therapy reduces functional mitral regurgitation during dynamic exercise in patients with chronic heart failure: an acute echocardiographic study Heart, August 1, 2006; 92(8): 1091 - 1095. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. A. Timek, D. T. Lai, P. Dagum, D. Liang, G. T. Daughters, N. B. Ingels Jr, and D. C. Miller Mitral Leaflet Remodeling in Dilated Cardiomyopathy Circulation, July 4, 2006; 114(1_suppl): I-518 - I-523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Kuwahara, Y. Otsuji, Y. Iguro, T. Ueno, F. Zhu, N. Mizukami, K. Kubota, K. Nakashiki, T. Yuasa, B. Yu, et al. Mechanism of Recurrent/Persistent Ischemic/Functional Mitral Regurgitation in the Chronic Phase After Surgical Annuloplasty: Importance of Augmented Posterior Leaflet Tethering Circulation, July 4, 2006; 114(1_suppl): I-529 - I-534. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Daimon, S. Fukuda, D. H. Adams, P. M. McCarthy, A. M. Gillinov, A. Carpentier, F. Filsoufi, V. M. Abascal, V. H. Rigolin, S. Salzberg, et al. Mitral Valve Repair With Carpentier-McCarthy-Adams IMR ETlogix Annuloplasty Ring for Ischemic Mitral Regurgitation: Early Echocardiographic Results From a Multi-Center Study Circulation, July 4, 2006; 114(1_suppl): I-588 - I-593. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Messas, A. Bel, M. C. Morichetti, C. Carrion, M. D. Handschumacher, S. Peyrard, J. T. Vilquin, M. Desnos, P. Bruneval, A. Carpentier, et al. Autologous Myoblast Transplantation for Chronic Ischemic Mitral Regurgitation J. Am. Coll. Cardiol., May 16, 2006; 47(10): 2086 - 2093. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.A. Grossi, Y.J. Woo, C.F. Schwartz, D.M. Gangahar, V.A. Subramanian, N. Patel, J. Wudel, P.L. DiGiorgi, A. Singh, and R.D. Davis Comparison of Coapsys annuloplasty and internal reduction mitral annuloplasty in the randomized treatment of functional ischemic mitral regurgitation: Impact on the left ventricle J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 1095 - 1098. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. V. Ennezat, S. Marechaux, T. Le Tourneau, N. Lamblin, C. Bauters, E. Van Belle, B. Gal, S. Kacet, P. Asseman, G. Deklunder, et al. Myocardial asynchronism is a determinant of changes in functional mitral regurgitation severity during dynamic exercise in patients with chronic heart failure due to severe left ventricular systolic dysfunction Eur. Heart J., March 2, 2006; 27(6): 679 - 683. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. De Simone, I. Wolf, S. Mottl-Link, R. Hoda, B. Mikhail, F.-U. Sack, H.-P. Meinzer, and S. Hagl A clinical study of annular geometry and dynamics in patients with ischemic mitral regurgitation: new insights into asymmetrical ring annuloplasty Eur. J. Cardiothorac. Surg., March 1, 2006; 29(3): 355 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair? J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 565 - 573.e2.
|
|
|
|
|
|
M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink? Ann. Thorac. Surg., March 1, 2006; 81(3): 1153 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. Brandt, C. Reiner, R. Arnold, J. Sperzel, H. F. Pitschner, and C. W. Hamm Contractile response and mitral regurgitation after temporary interruption of long-term cardiac resynchronization therapy Eur. Heart J., January 2, 2006; 27(2): 187 - 192. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Porciani, R. Macioce, G. Demarchi, M. Chiostri, N. Musilli, F. Cappelli, A. Lilli, G. Ricciardi, and L. Padeletti Effects of cardiac resynchronization therapy on the mechanisms underlying functional mitral regurgitation in congestive heart failure Eur J Echocardiogr, January 1, 2006; 7(1): 31 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Bax, T. Abraham, S. S. Barold, O. A. Breithardt, J. W.H. Fung, S. Garrigue, J. Gorcsan III, D. L. Hayes, D. A. Kass, J. Knuuti, et al. Cardiac Resynchronization Therapy: Part 2--Issues During and After Device Implantation and Unresolved Questions J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2168 - 2182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Fukuda, R. Grimm, J.-M. Song, T. Kihara, M. Daimon, D. A. Agler, B. L. Wilkoff, A. Natale, J. D. Thomas, and T. Shiota Electrical Conduction Disturbance Effects on Dynamic Changes of Functional Mitral Regurgitation J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2270 - 2276. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Grossi, P. C. Saunders, Y. J. Woo, D. M. Gangahar, J. C. Laschinger, D. C. Kress, M. P. Caskey, C. F. Schwartz, and J. Wudel Intraoperative Effects of the Coapsys Annuloplasty System in a Randomized Evaluation (RESTOR-MV) of Functional Ischemic Mitral Regurgitation Ann. Thorac. Surg., November 1, 2005; 80(5): 1706 - 1711. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Giga, M. Ostojic, B. Vujisic-Tesic, A. Djordjevic-Dikic, J. Stepanovic, B. Beleslin, M. Petrovic, M. Nedeljkovic, I. Nedeljkovic, and N. Milic Exercise-induced changes in mitral regurgitation in patients with prior myocardial infarction and left ventricular dysfunction: relation to mitral deformation and left ventricular function and shape Eur. Heart J., September 2, 2005; 26(18): 1860 - 1865. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-Y. Yu, M.-Y. Su, Y.-S. Chen, F.-Y. Lin, and W.-Y. I. Tseng Mitral tetrahedron as a geometrical surrogate for chronic ischemic mitral regurgitation Am J Physiol Heart Circ Physiol, September 1, 2005; 289(3): H1218 - H1225. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Langer, F. Rodriguez, S. Ortiz, A. Cheng, T. C. Nguyen, M. K. Zasio, D. Liang, G. T. Daughters, N. B. Ingels, and D. C. Miller Subvalvular Repair: The Key to Repairing Ischemic Mitral Regurgitation? Circulation, August 30, 2005; 112(9_suppl): I-383 - I-389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Zhu, Y. Otsuji, G. Yotsumoto, T. Yuasa, T. Ueno, B. Yu, C. Koriyama, S. Hamasaki, S. Biro, A. Kisanuki, et al. Mechanism of Persistent Ischemic Mitral Regurgitation After Annuloplasty: Importance of Augmented Posterior Mitral Leaflet Tethering Circulation, August 30, 2005; 112(9_suppl): I-396 - I-401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|