Local dysfunction and asymmetrical deformation of mitral annular geometry in ischemic mitral regurgitation: a novel computerized 3D echocardiographic analysis.
OBJECTIVE
Most studies of the pathogenesis of functional mitral regurgitation (MR) have focused on alterations in ventricular function and geometry. We used a novel 3D echocardiographic method to assess abnormalities in mitral annular (MA) geometry and motion in patients with ischemic MR (IMR) and compared these data to those obtained from normal subjects and from patients with MR caused by dilated cardiomyopathy (DMR).


METHODS
Real time 3D echo was performed in 12 normal subjects, 25 with IMR, and 14 with DMR. Eight points along the saddle-shaped MA were identified using our software at systole and diastole. From these eight points, four annular diameters at each cardiac phase were determined. Annular motion was assessed by measuring local displacement (LD) of a given point between systole and diastole.


RESULTS
Annular motion was different between groups: IMR had smaller LD in posterior MA segments than did normals (2.6 +/- 1.1 vs 4.8 +/- 1.9 mm, P < 0.01), while DMR had globally reduced LD. In IMR systolic MA dilatation was striking in the anterior-posterior (diameter; IMR vs controls, 28.3 +/- 3.5 vs 22.5 +/- 2.2 mm, P< 0.05) and anterolateral-posteromedial (31.7 +/- 3.5 vs 25.1 +/- 2.2 mm, P < 0.05) directions; in IMR, systolic MA diameters in these two directions correlated with MR severity(P = 0.02). MA dilatation occurred globally in DMR.


CONCLUSIONS
This novel 3D echo method demonstrated that MA motion and dilatation were asymmetric in IMR and symmetric in DMR. These differences in MA geometry and motion may aid in the development of distinct new therapies for IMR and DMR.
Daimon
Masao
M
Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Saracino
Giuseppe
G
Gillinov
A Marc
AM
Koyama
Yasushi
Y
Fukuda
Shota
S
Kwan
Jun
J
Song
Jong-Min
JM
Kongsaerepong
Vorachai
V
Agler
Deborah A
DA
Thomas
James D
JD
Shiota
Takahiro
T
D000328:Adult; D002306:Cardiac Volume / Q000502:physiology; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*