title: Dynamic change of mitral annular geometry and motion in ischemic mitral regurgitation assessed by a computerized 3D echo method.
abstract: OBJECTIVE
  In patients with ischemic mitral regurgitation (IMR), we assessed dynamic changes in mitral annular geometry and motion during the cardiac cycle, and examined their association with the severity of IMR, using our computerized three-dimensional (3D) echo method.
  
  
  METHODS
  Real-time 3D echo was performed in 12 normal controls and 25 patients with IMR. The saddle-shaped annulus was reconstructed in every 3D volume/frame during a cardiac cycle. For each 3D volume/frame, we assessed the mitral annular area (MAA) and the annular contraction that was expressed as the percentage of the largest MAA accounted for by the change in MAA from largest to smallest calculated value.
  
  
  RESULTS
  In IMR patients, the minimum MAA occurred in late-systole, while it occurred in early-systole in the controls. IMR patients had a larger minimum MAA (6.7 ± 1.3 vs. 3.6 ± 0.8 cm², P < 0.001) and reduced annular contraction (23.0 ± 6.5 vs. 42.6 ± 7.0%, P < 0.001) when compared to controls. Both minimum MAA and annular contraction had significant correlations with IMR severity (r = 0.67 and r = 0.78, P < 0.001 for both).
  
  
  CONCLUSIONS
  The contraction of the dilated mitral annulus occurred in late-systole in patients with IMR. The alterations of annular geometry and motion may be associated with the development of IMR.
authors.affiliation: Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Saracino
authors.forename: Shota
authors.initials: S
authors.lastname: Fukuda
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Koyama
authors.forename: Jun
authors.initials: J
authors.lastname: Kwan
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Agler
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000465:Algorithms; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging*; D009038:Motion; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity