title: Relationship between mitral annulus function and mitral regurgitation severity and left atrial remodelling in patients with primary mitral regurgitation.
abstract: OBJECTIVE
  To explore the relationship between the mitral annular (MA) remodelling and dysfunction, mitral regurgitation (MR) severity, left ventricular (LV) and atrial (LA) size and function in patients with organic MR (OMR).
  
  
  RESULTS
  A total of 52 patients (57 ± 15 years, 31 men) with mild to severe OMR and 52 controls underwent 3D transthoracic echocardiography acquisitions of the mitral valve (MV), LA, and LV. MA geometry and dynamics, LV and LA volumes, LV ejection fraction (LVEF) and emptying fractions (LAEF) were assessed using dedicated software packages. LA and LV myocardial deformations were assessed using 2D speckle-tracking echocardiography. OMR patients presented larger and more spherical MA than controls during the entire systole (P < 0.001). Although the MA non-planarity at early-systole was similar between OMR and controls (157 ± 13° vs. 153 ± 12°, P = NS), the MA became flatter from mid- to end-systole (153 ± 12 vs. 146 ± 10° and 157 ± 12 vs. 147 ± 8°, P < 0.01) in OMR. MA area fractional change was lower in patients with OMR (22 ± 5% vs. 28 ± 5%, P < 0.001), and correlated with the MR orifice and volume (r = -0.52 and r = -0.55). MA fractional area change correlated with LA minimum and maximum volumes (r = 0.77 and r = 0.70), total and active LAEF (r = 0.72 and r = 0.76), and LA negative strain and strain rate (r = 0.52 and r = 0.57), but not with the LVEF or LV global longitudinal strain. In a multivariate regression model using LAEF and LVEF, solely active LAEF correlated with the MA fractional area change (β = 0.51, P = 0.005).
  
  
  CONCLUSIONS
  In patients with OMR, MA reduced function correlates with the MR severity and the LA size and function, but not with the LV function.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania sorinamihaila@yahoo.com.
authors.forename: Sorina
authors.initials: S
authors.lastname: Mihaila
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Denisa
authors.initials: D
authors.lastname: Muraru
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcelo Haertel
authors.initials: MH
authors.lastname: Miglioranza
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Piasentini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Aruta
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cucchini
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani 2, CAP 35128 Padua, Italy.
authors.forename: Luigi P
authors.initials: LP
authors.lastname: Badano
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D064752:Atrial Remodeling / Q000502:physiology*; D016022:Case-Control Studies; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery; D015999:Multivariate Analysis; D015588:Observer Variation; D011379:Prognosis; D012016:Reference Values; D012044:Regression Analysis; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: mitral annulus dysfunction; mitral valve; organic mitral regurgitation; three-dimensional echocardiography; transthoracic echocardiography