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Geometric predictor of significant mitral regurgitation in patients with severe ischemic cardiomyopathy, undergoing Dor procedure: a real-time 3D echocardiographic study.

BACKGROUND AND PURPOSE: Significant mitral regurgitation (MR) is frequently associated with coronary artery disease. The precise geometric predictors of significant MR in ischemic cardiomyopathy are not clearly defined. We performed real-time 3D echocardiography (RT3DE) in 48 patients scheduled for...

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Published in:European Journal of Echocardiography Vol. 8; no. 3; pp. 195 - 204
Main Authors: Kwan J, Gillinov MA, Thomas JD, Shiota T
Format: diagnostic images research tables/charts Journal Article
Published: Oxford University Press / USA Jun2007
Online Access:View this record in EBSCOhost
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      dt: Jun2007
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      pub: Oxford University Press / USA
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        atl: Geometric predictor of significant mitral regurgitation in patients with severe ischemic cardiomyopathy, undergoing Dor procedure: a real-time 3D echocardiographic study.
      aug:
        au:
          Kwan J
          Gillinov MA
          Thomas JD
          Shiota T
        affil: Department of Cardiology, Inha University Hospital, 7-206, 3-Ga, Shinheung-Dong, Jung-Gu, Inchon 400-711, Republic of Korea.
      sug:
        subj:
          Echocardiography, Three-Dimensional
          Mitral Valve Insufficiency Diagnosis
          Myocardial Ischemia
          Coronary Disease Diagnosis
          Coronary Vessels
          Descriptive Statistics
          Echocardiography, Doppler, Color
          Female
          Funding Source
          Heart Ventricle, Left
          Male
          Middle Age
          Mitral Valve
          Mitral Valve Insufficiency Risk Factors
          Multivariate Analysis
          ROC Curve
          Sensitivity and Specificity
          Step-Wise Multiple Regression
          Ventricular Dysfunction, Left
          Ventricular Ejection Fraction
          Human
          Middle Aged: 45-64 years
          Female
          Male
      ab: BACKGROUND AND PURPOSE: Significant mitral regurgitation (MR) is frequently associated with coronary artery disease. The precise geometric predictors of significant MR in ischemic cardiomyopathy are not clearly defined. We performed real-time 3D echocardiography (RT3DE) in 48 patients scheduled for infarct exclusion surgery or Dor procedure, 22 of whom had moderate or severe MR (DorMR) and 26 with no or trivial MR (DorNoMR). METHODS: Two orthogonal apical volumetric planes of LV, commissure-commissure (CC) and antero-posterior (AP) planes, were generated during mid-systole. Mitral valve tenting height (MVTht) and area (MVTa) were measured. The degree of leaflet tethering was estimated by the angles between the annular plane and each leaflet (anterior leaflet: Aalpha, posterior leaflet: Palpha). RESULTS: MVTht (1.11+/-0.14 vs 0.78+/-0.20cm, P<0.01) and MVTa (1.30+/-0.34 vs 0.87+/-0.27cm(2), P<0.01) were significantly larger in DorMR compared with DorNoMR. In DorMR, both Aalpha (38+/-6 vs 31+/-7 degrees , P<0.01) and Palpha (60+/-7 vs 41+/-8 degrees , P<0.01) significantly increased more than those in DorNoMR. Multiple logistic regression analysis found Palpha to be the most important geometric predictor of significant MR. MV tenting area was found to be the strongest determinant of MR severity in ischemic cardiomyopathy patients with significant MR by multivariate linear regression analysis. CONCLUSIONS: Detecting significant posterior leaflet tethering, the most important predictor of significant MR, and measuring MV tenting area, the strongest determinant of MR severity, using RT3DE may be helpful in decision making of additive surgical intervention for MR in patients with severe ischemic cardiomyopathy.
      pubtype: Academic Journal
      doctype:
        diagnostic images
        research
        tables/charts
        Journal Article
      ougenre: Article
    language: English
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