title: Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial).
abstract: The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR.
authors.affiliation: Medical University of Silesia, Katowice, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Golba
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mokrzycki
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Drozdz
authors.forename: Alexander
authors.initials: A
authors.lastname: Cherniavsky
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wrobel
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Roberts
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Michael
authors.initials: M
authors.lastname: Yii
authors.forename: Federico M
authors.initials: FM
authors.lastname: Asch
authors.forename: Mark D
authors.initials: MD
authors.lastname: Handschumacher
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.forename: Irving
authors.initials: I
authors.lastname: Kron
authors.forename: Hartzell
authors.initials: H
authors.lastname: Schaff
authors.forename: Susan
authors.initials: S
authors.lastname: Aston
authors.forename: John
authors.initials: J
authors.lastname: Horton
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Lee
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000209:etiology; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume
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