AI Article Synopsis

  • The study investigated the mechanisms behind functional mitral regurgitation (MR) in a large trial of 215 patients across 17 centers, using transesophageal echocardiography (TEE) for detailed assessments.
  • Multiple measurements, both 2-dimensional and 3-dimensional, revealed that various factors, like leaflet angles and left ventricular metrics, differed significantly with MR severity.
  • Despite identifying numerous quantitative parameters related to MR severity, no one variable was identified as a strong predictor, highlighting the complex and varied nature of functional MR in patients with ischemic cardiomyopathy.

Article Abstract

The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830629PMC
http://dx.doi.org/10.1016/j.amjcard.2013.07.047DOI Listing

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