title: Functional mitral regurgitation in patients with aortic stenosis: prevalence, clinical correlates and pathophysiological determinants: a quantitative prospective study.
abstract: OBJECTIVE
  In patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.
  
  
  RESULTS
  We prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50% female, EF 57 ± 14%, AVA 1.00 ± 0.4 cm(2)). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm(2)). ERO was significantly associated with LVD (rho = 0.34; P = 0.0001), EF (r(s) = -0.35: P = 0.0001), and S-DTI (r = -0.57; P = 0.0001), A-DTI (rho = -0.47; P = 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m(2) and EF >55%), S-DTI, and A-DTI were the variables with the more powerful association with ERO (r(s) = -0.49 P = 0.0001 and r(s) = -0.40 P = 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: r(s) = -0.08 P = 0.2 and AVA: r(s) = -0.08 P = 0.2).
  
  
  CONCLUSIONS
  In AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy andrea.rossi@ospedaleuniverona.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Dandale
authors.affiliation: Cardiology Service, CMSR Veneto Medica, Altavilla Vicentina, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Nistri
authors.affiliation: Cardiology Unit, Spedali Civili Brescia, Brescia, Italy.
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy.
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Benfari
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Department of Surgery, Section of Cardiac Surgery, University of Verona, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: David
authors.initials: D
authors.lastname: Messika-Zeitoun
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.affiliation: Department of Medicine, Section of Cardiology, University of Verona, P. le Stefani 1, 37126 Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors
keywords: aortic stenosis; echocardiography; functional mitral regurgitation; left ventricular function