title: Echocardiographic determinants of ischemic mitral regurgitation.
abstract: OBJECTIVE
  It is not clear whether the presence and degree of chronic ischemic mitral regurgitation (IMR) in patients with left ventricular (LV) dysfunction are related to LV dysfunction, local LV remodeling or mitral valve deformation. We sought to establish the strongest determinants of IMR severity in patients with LV dysfunction and IMR.
  
  
  METHODS
  We prospectively performed transthoracic echocardiography for 135 patients (mean age = 60.76 ± 9.69 years, 71.9% male) with LV dysfunction (ejection fraction ≤ 50%) and coronary artery disease (70% stenosis in ≥ 1 coronary artery and no myocardial infarction during the previous 16 days). Global and local LV remodeling and mitral deformity indices were measured. Using the vena contracta, MR severity was graded as no regurgitation; mild; moderate; and severe.
  
  
  RESULTS
  Mild regurgitation was found in 45 (33.3%) patients, moderate in 71 (52.6%), severe in 6 (4.4%), and no regurgitation in 13 (9.6%). By linear logistic multivariable analysis, the major echocardiographic determinants of MR severity were tenting area (TA), sphericity index (LV systolic length/width), and C-septal (distance between the leaflet coaptation and the septum). TA was best related to coaptation depth and annulus diameter. Mitral annular diameter was best correlated with left atrial surface area (r = 0.630, p < 0.001).
  
  
  CONCLUSIONS
  TA was significantly correlated with annulus diameter and, along with sphericity index and C-septal, were the independent echocardiographic determinants of MR severity. These findings warrant consideration when performing mitral valve repairs for patients with IMR.
authors.affiliation: Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Masoumeh
authors.initials: M
authors.lastname: Nouri
authors.forename: Masoumeh Lotfi
authors.initials: ML
authors.lastname: Tokaldany
authors.forename: Maryam
authors.initials: M
authors.lastname: Shahrzad
authors.forename: Azam Safir
authors.initials: AS
authors.lastname: Mardanloo
authors.forename: Seyyed Hossein
authors.initials: SH
authors.lastname: Ahmadi
authors.forename: Zahra Savand
authors.initials: ZS
authors.lastname: Roomi
authors.forename: Hakimeh
authors.initials: H
authors.lastname: Sadeghian
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging; D020257:Ventricular Remodeling