title: Three-dimensional assessment of left ventricular geometry and annular dilatation provides new mechanistic insights into the surgical correction of ischemic mitral regurgitation.
abstract: BACKGROUND
  The aim of this study was to investigate the relationship between LV geometry, annular shape and the amount of regurgitation in patients with ischemic mitral regurgitation (group 1, n = 30) compared to patients with primary mitral valve lesions (group 2, n = 30).
  
  
  METHODS
  LV geometry was assessed by the sphericity index, i.e., LV volume divided by the volume of a sphere with a diameter equal to the longest axis. Annular geometry was evaluated by diameters, areas and their percentual shortening. The degree of mitral regurgitation was assessed as jet volumes by 3D-echocardiography.
  
  
  RESULTS
  Group 1 showed significantly larger longitudinal (54.3 +/- 3.1 vs. 40.9 +/- 2.6 mm) and antero-posterior (32.2 +/- 3.3 vs. 27.1 +/- 2.9 mm) annulus diameters and areas (993.3 +/- 66.6 vs. 702.1 +/- 47.9 mm (2)) than group 2. No asymmetric annular enlargement was found in either group. Annular enlargement correlated to the degree of mitral regurgitation in group 1 but not in group 2. Annular area shortening was significantly impaired in group 2 and the sphericity index was larger in group 1 than in group 2. In group 1, the sphericity index was significantly correlated to the degree of mitral regurgitation (r = 0.87; P < 0.001).
  
  
  CONCLUSIONS
  These findings suggest that ischemic mitral regurgitation was mostly associated with a global left ventricular enlargement, in which annulus dilatation and its reduced contraction play a significant role.
authors.affiliation: Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany. r.de.simone@urz.uni-heidelberg.de
authors.forename: R
authors.initials: R
authors.lastname: De Simone
authors.forename: I
authors.initials: I
authors.lastname: Wolf
authors.forename: R
authors.initials: R
authors.lastname: Hoda
authors.forename: B
authors.initials: B
authors.lastname: Mikhail
authors.forename: S
authors.initials: S
authors.lastname: Mottl-Link
authors.forename: H-P
authors.initials: HP
authors.lastname: Meinzer
authors.forename: S
authors.initials: S
authors.lastname: Hagl
mesh_terms: D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020257:Ventricular Remodeling