Eclipsed mitral regurgitation: a new form of functional mitral regurgitation for an unusual cause of heart failure with normal ejection fraction.
BACKGROUND
Transient functional mitral regurgitation (MR) has never been reported as a cause of heart failure (HF) with normal ejection fraction (EF) in the absence of epicardial coronary artery stenosis.


RESULTS
Performance of echocardiography in patients with acute HF before initiation of HF medical treatment allowed identification of three patients with normal EF but transient massive functional MR during the HF episode. In all patients, massive MR occurred as a consequence of sudden extreme apical tenting of both leaflets with total lack of coaptation, despite normal EF and absence of detectable left ventricular (LV) remodeling, and despite absence of significant stenosis on coronary arteries. In all patients MR was triggered by methylergonovine injection and was reversible either spontaneously or after nitroglycerine administration, leaving patients with normal echocardiogram between HF episodes. In two patients, long-term administration of calcium channel blockers prevented recurrences of MR and HF, whereas in one, mitral valve was eventually replaced.


CONCLUSIONS
Sudden reversible apical tenting of mitral leaflets with subsequent torrential MR and acute HF can occur despite normal EF, absence of pre-existing LV remodeling and absence of coronary artery stenosis. This atypical type of functional MR is an unusual mechanism of HF in patients with normal LVEF.
Avierinos
Jean-François
JF
Cardiology Department, Timone Hospital, Marseille, France. jfavierinos@ap-hm.fr
Thuny
Franck
F
Tafanelli
Laurence
L
Renard
Sebastien
S
Chalvignac
Virginie
V
Guedj
Eric
E
Lambert
Marc
M
Quilici
Jacques
J
Bonnet
Jean-Louis
JL
Enriquez-Sarano
Maurice
M
Habib
Gilbert
G
D000208:Acute Disease; D000368:Aged; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D011379:Prognosis; D011877:Radionuclide Imaging / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D013793:Thallium; D013794:Thallium Radioisotopes; D020257:Ventricular Remodeling / Q000502:physiology
D013794:Thallium Radioisotopes; D013793:Thallium