Echocardiographic evaluation of the relationship between pattern of left ventricular dilation and functional mitral regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Lu ,  GU Tianxiang , FANG Qin , ZHANG Guangwei

Department of Cardiac Surgery, The First Hospital of China Medical University, Shenyang, 110001, P.R.China;

Corresponding author：

GU Tianxiang, Email: cmugtx@sina.com

Keywords：

Echocardiography; left ventricular dilation; functional mitral regurgitation; mitral valve repair

DOI：

10.7507/1007-4848.201601021

Video：

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Objective To evaluate the relationship between pattern of left ventricular dilation and functional mitral regurgitation (FMR) by echocardiography. Methods A single-center retrospective observational study was conducted on 117 patients with age of 31-77 years and left ventricular end diastolic dimension≥60 mm treated in our hospital from January 2013 through May 2016. These patients were divided into four groups by FMR degree: FMR-None/Trace (FMR-N/T group,n=33), FMR-Minor (FMR-Mi group,n=37), FMR-Moderate (FMR-Mo group,n=34) and FMR-Severe (FMR-Se group,n=13). We analyzed their basic information and echocardiographic parameters including left ventricular dimension, volume, systolic function, spherical index, regional wall motion score index, tenting height and area of mitral vavle as well as anterior/posterior angle. Results The incidences of inferior/posterior/lateral myocardial infarction and basal myocardial dyskinesia/aneurysm increased with the increase of FMR degree (FMR-N/T vs. FMR-Mi vs. FMR-Mo vs. FMR-Se: 12.1% vs. 18.9% vs. 44.1% vs. 46.2%,P=0.001 and 12.1% vs. 27.0% vs.47.1% vs. 53.8%,P=0.005, respectively). The tenting height and area of mitral valve, anterior/posterior angle, regional wall score index of the left ventricle where the papillary muscle was attached to had a positive correlation with FMR degree (P＜0.05). Conclusion There is a relationship between regional left ventricular dilation and FMR. Evaluating and improving those parameters is very important when we choose the treatment strategy of functional mitral regurgitaion.

Citation： LIU Lu, GU Tianxiang, FANG Qin, ZHANG Guangwei. Echocardiographic evaluation of the relationship between pattern of left ventricular dilation and functional mitral regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(1): 43-47. doi: 10.7507/1007-4848.201601021 Copy

1.	Kron IL, Hung J, Overbey JR, et al. Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. J Thorac Cardiovasc, 2015, 149(3): 752-761.
2.	Gelsomin S, Lorusso R, De Cicco G, et al. Five year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation. Eur Heart J, 2008, 29(2): 231-240.
3.	McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 2004, 128(5): 916-924.
4.	Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr, 1989, 2(5): 358-367.
5.	D’Cruz IA, Shroff SG, Janicki JS, et al. Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle. J Am Soc Echocardiog, 1989, 2(6): 408-414.
6.	Grigioni F, Enriquez-Sarano M, Zehr KJ, et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation, 2001, 103(13): 1759-1764.
7.	Tigen K, Karaahmet T, Dundar C, et al. The importance of papillary muscle dyssynchrony in predicting the severity of functional mitral regurgitation in patients with non-ischaemic dilated cardiomyopathy: a two-dimensional speckle-tracking echocardiography study. Eur J Echocardiogr, 2010, 11(8): 671-676.
8.	Enriquez-Sarano M, Seward JB, Bailey KR, et al. Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept. J Am Coll Cardiol, 1994, 23(2): 443-451.
9.	Acker MA, Dagenais F, Goldstein D, et al. Severe ischemic mitral regurgitation: Repair or replace? J Thorac Cardiovasc Surg, 2015, 150(6): 1425-1427.
10.	LaPar DJ, Acker MA, Gelijns AC, et al. Repair or replace for severe ischemic mitral regurgitation: prospective randomized multicenter data. Ann Cardiothorac Surg, 2015, 4(5): 411-416.
11.	D’ascenzo F, Moretti C, Marra WG, et al. Meta-analysis of the usefulness of Mitraclip in patients with functional mitral regurgitation. Am J Cardiol, 2015, 116(2): 325-331.
12.	Acker MA, Parides MK, Perrault LP, et al. Mitral valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med, 2014, 370(1): 23-32.
13.	Vassileva CM, Boley T, Markwell S, et al. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. Eur J Cardiothorac Surg, 2011, 39(3): 295-303.
14.	Ciarka A, Braun J, Delgado V, et al. Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty. Am J Cardiol, 2010, 106(3): 395-401.
15.	Fattouch K, Guccione F, Sampognaro R, et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
16.	Fattouch K, Sampognaro R, Speziale G, et al. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting. Ann Thorac Surg, 2010, 90(4): 1187-1194.
17.	Tops LF, Delgado V, Bax JJ. The role of speckle tracking strain imaging in cardiac pacing. Echocardiography, 2009, 26(3): 315-323.
18.	Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging, 2009, 2(5): 356-364.
19.	Moonen M, Lancellotti P, Zacharakis D, et al. The value of 2D strain imaging during stress testing. Echocardiography, 2009, 26(3): 307-314.
20.	Lancellotti P, Cosyns B, Zacharakis D, et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr, 2008, 21(12): 1331-1336.

1. Kron IL, Hung J, Overbey JR, et al. Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation. J Thorac Cardiovasc, 2015, 149(3): 752-761.
2. Gelsomin S, Lorusso R, De Cicco G, et al. Five year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation. Eur Heart J, 2008, 29(2): 231-240.
3. McGee EC, Gillinov AM, Blackstone EH, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg, 2004, 128(5): 916-924.
4. Schiller NB, Shah PM, Crawford M, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr, 1989, 2(5): 358-367.
5. D’Cruz IA, Shroff SG, Janicki JS, et al. Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle. J Am Soc Echocardiog, 1989, 2(6): 408-414.
6. Grigioni F, Enriquez-Sarano M, Zehr KJ, et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation, 2001, 103(13): 1759-1764.
7. Tigen K, Karaahmet T, Dundar C, et al. The importance of papillary muscle dyssynchrony in predicting the severity of functional mitral regurgitation in patients with non-ischaemic dilated cardiomyopathy: a two-dimensional speckle-tracking echocardiography study. Eur J Echocardiogr, 2010, 11(8): 671-676.
8. Enriquez-Sarano M, Seward JB, Bailey KR, et al. Effective regurgitant orifice area: a noninvasive Doppler development of an old hemodynamic concept. J Am Coll Cardiol, 1994, 23(2): 443-451.
9. Acker MA, Dagenais F, Goldstein D, et al. Severe ischemic mitral regurgitation: Repair or replace? J Thorac Cardiovasc Surg, 2015, 150(6): 1425-1427.
10. LaPar DJ, Acker MA, Gelijns AC, et al. Repair or replace for severe ischemic mitral regurgitation: prospective randomized multicenter data. Ann Cardiothorac Surg, 2015, 4(5): 411-416.
11. D’ascenzo F, Moretti C, Marra WG, et al. Meta-analysis of the usefulness of Mitraclip in patients with functional mitral regurgitation. Am J Cardiol, 2015, 116(2): 325-331.
12. Acker MA, Parides MK, Perrault LP, et al. Mitral valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med, 2014, 370(1): 23-32.
13. Vassileva CM, Boley T, Markwell S, et al. Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation. Eur J Cardiothorac Surg, 2011, 39(3): 295-303.
14. Ciarka A, Braun J, Delgado V, et al. Predictors of mitral regurgitation recurrence in patients with heart failure undergoing mitral valve annuloplasty. Am J Cardiol, 2010, 106(3): 395-401.
15. Fattouch K, Guccione F, Sampognaro R, et al. POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: a randomized trial. J Thorac Cardiovasc Surg, 2009, 138(2): 278-285.
16. Fattouch K, Sampognaro R, Speziale G, et al. Impact of moderate ischemic mitral regurgitation after isolated coronary artery bypass grafting. Ann Thorac Surg, 2010, 90(4): 1187-1194.
17. Tops LF, Delgado V, Bax JJ. The role of speckle tracking strain imaging in cardiac pacing. Echocardiography, 2009, 26(3): 315-323.
18. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging, 2009, 2(5): 356-364.
19. Moonen M, Lancellotti P, Zacharakis D, et al. The value of 2D strain imaging during stress testing. Echocardiography, 2009, 26(3): 307-314.
20. Lancellotti P, Cosyns B, Zacharakis D, et al. Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr, 2008, 21(12): 1331-1336.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Echocardiographic evaluation of the relationship between pattern of left ventricular dilation and functional mitral regurgitation

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