title: Comparison of Transesophageal and Transthoracic Echocardiographic Measurements of Mechanism and Severity of Mitral Regurgitation in Ischemic Cardiomyopathy (from the Surgical Treatment of Ischemic Heart Failure Trial).
abstract: Mitral regurgitation (MR) is common in ischemic heart disease and contributes to symptoms and mortality. This report compares the results of baseline transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) imaging of the mechanism and severity of functional MR in patients with ischemic cardiomyopathy in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Independent core laboratories measured both TTE and TEE images on 196 STICH participants. Common measurements to both models included MR grade, mitral valve tenting height and tenting area, and mitral annular diameter. For each parameter, correlations were assessed using Spearman rank correlation coefficients. A modest correlation was present between TEE and TTE for overall MR grade (n = 176, r = 0.52). For mechanism of MR, modest correlations were present for long-axis tenting height (n = 152, r = 0.35), tenting area (n = 128, r = 0.27), and long-axis mitral annulus diameter (n = 123, r = 0.41). For each measurement, there was significant scatter. Potential explanations for the scatter include different orientation of the imaging planes between TEE and TTE, a mean temporal delay of 6 days between TEE and TTE, and statistically significant differences in heart rate and blood pressure and weight between studies. In conclusion, TEE and TTE measurements of MR mechanism and severity correlate only modestly with enough scatter in the data that they are not interchangeable.
authors.affiliation: Department of Internal Medicine, Cardiology Section, Baylor University Medical Center, Dallas, Texas. Electronic address: paulgr@baylorhealth.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Grayburn
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Lilin
authors.initials: L
authors.lastname: She
authors.affiliation: Department of Internal Medicine, Cardiology Section, Baylor University Medical Center, Dallas, Texas.
authors.forename: Brad J
authors.initials: BJ
authors.lastname: Roberts
authors.affiliation: Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.
authors.forename: Krzysztof S
authors.initials: KS
authors.lastname: Golba
authors.affiliation: Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Mokrzycki
authors.affiliation: Medical University of Lodz, Lodz, Poland.
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Drozdz
authors.affiliation: Research Institute of Circulation Pathology, Novosibirsk, Russia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cherniavsky
authors.affiliation: Silesian Center for Heart Diseases, Silesian Medical University, Zabrze, Poland.
authors.forename: Roman
authors.initials: R
authors.lastname: Przybylski
authors.affiliation: Allenort Hospital, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Wrobel
authors.affiliation: MedStar Washington Hospital Center, Washington, District of Columbia.
authors.forename: Federico M
authors.initials: FM
authors.lastname: Asch
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Holly
authors.affiliation: University of Ottawa Heart Institute, Ottawa, Canada.
authors.forename: Haissam
authors.initials: H
authors.lastname: Haddad
authors.affiliation: St. Vincent's Hospital-Melbourne and University of Melbourne Department of Surgery, Melbourne, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Yii
authors.affiliation: Medical University of Vienna, Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.affiliation: University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Irving
authors.initials: I
authors.lastname: Kron
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Hartzell
authors.initials: H
authors.lastname: Schaff
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Medicine-Cardiology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.affiliation: Mayo Clinic, Rochester, Minnesota.
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000000981:diagnostic imaging*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging*; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging*; D009929:Organ Size; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric