title: Role of regional mechanical dyssynchrony as a determinant of functional mitral regurgitation in patients with left ventricular systolic dysfunction.
abstract: OBJECTIVE
  To assess regional mechanical dyssynchrony as a determinant of the degree of functional mitral regurgitation (FMR).
  
  
  METHODS
  Tertiary cardiology clinic.
  
  
  METHODS
  74 consecutive patients with left ventricular (LV) dysfunction (ejection fraction < 40%, mean 32.2 (SD 7.3)%) were evaluated.
  
  
  METHODS
  Effective regurgitant orifice (ERO) area, indices of mitral deformation (systolic valvular tenting, mitral annular contraction) and of global LV function and remodelling (ejection fraction, end systolic volume, sphericity index) and local remodelling (papillary-fibrosa distance, regional wall motion score index), and tissue Doppler-derived dyssynchrony index (DI) (regional DI, defined as the standard deviation of time to peak myocardial systolic contraction of eight LV segments supporting the papillary muscles attachment) were measured.
  
  
  RESULTS
  All the assessed variables correlated significantly with ERO. By multivariate analysis, systolic valvular tenting was the strongest independent predictor of ERO (R(2) = 0.77, p = 0.0001), with a minor influence of papillary-fibrosa distance (R(2) = 0.77, p = 0.01) and regional DI (R(2) = 0.77, p = 0.03). Local LV remodelling (regional wall motion score index: R(2) = 0.58, p = 0.001; papillary-fibrosa distance: R(2) = 0.58, p = 0.002) and global remodelling indices (sphericity index: R(2) = 0.58, p = 0.003) were the main determinants of systolic valvular tenting, whereas regional DI did not enter into the model. Regional DI was an independent predictor of ERO (R(2) = 0.56, p = 0.005) in patients with non-ischaemic LV dysfunction but not in patients with ischaemic LV dysfunction when these groups were analysed separately.
  
  
  CONCLUSIONS
  The degree of FMR is associated mainly with mitral deformation indices. The regional dyssynchrony also has an independent association with ERO but with a minor influence; however, it is not a determinant of FMR in patients with ischaemic LV dysfunction.
authors.affiliation: Division of Noninvasive Cardiology, Cardiothoracic Department, San Raffaele Hospital, IRCCS, Via Olgettina 60, 20132 Milan, Italy. agricola.eustachio@hsr.it
authors.forename: E
authors.initials: E
authors.lastname: Agricola
authors.forename: M
authors.initials: M
authors.lastname: Oppizzi
authors.forename: M
authors.initials: M
authors.lastname: Galderisi
authors.forename: M
authors.initials: M
authors.lastname: Pisani
authors.forename: A
authors.initials: A
authors.lastname: Meris
authors.forename: C
authors.initials: C
authors.lastname: Pappone
authors.forename: A
authors.initials: A
authors.lastname: Margonato
mesh_terms: D002302:Cardiac Output; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology* / Q000503:physiopathology; D015588:Observer Variation; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology; D020257:Ventricular Remodeling / Q000502:physiology