Korean Circ J.  2004 Jun;34(6):627-635. 10.4070/kcj.2004.34.6.627.

Etiologic Evaluation of Ischemic Mitral Regurgitation Using Cardiac MRI

• Choi EY
• Ko YG
• Jang Y
• Shim WH
• Rim SJ
• Chung N
• Cho SY
• Yoo KJ
• Choi BW

• KMID: 1858915
• DOI: http://doi.org/10.4070/kcj.2004.34.6.627

Abstract

BACKGROUND AND OBJECTIVES
To evaluate the 3 dimensional geometric changes and the effect of revascularization in patients with ischemic mitral regurgitation (IMR), using cardiac magnetic resonance imaging (MRI).
SUBJECTS AND METHODS
Twenty-three patients with IMR, 10 with dilated cardiomyopathy with MR (DCM-MR) and 7 control subjects were enrolled. Hemodynamic indices, severity of MR, geometric parameters of mitral apparatus and myocardial viability were evaluated in all patients, and re-evaluated in the IMR patients 6 months after the revascularization.
RESULTS
The mitral tenting area (TAA) (334.1+/-11.7 mm2 vs. 222.9+/-23.0 mm2, p=0.16) and the sum of the tenting angles (TA) (72.9+/-2.9degreevs. 51.5+/-1.1degree p<0.001) at the mid-systolic phase were increased in the IMR compared to the DCM-MR patients. In the IMR patients, the MR severity was positively correlated with the sum of the tethering lengths (r=0.522, p=0.011), LVESV (r=0.551, p=0.006), TAA (r=0.613, p=0.002) and TA (r=0.713, p<0.001). Of the 10 patients with viable myocardium, who had been revascularized without surgical repair of the mitral apparatus, the MR severity was decreased (28.3+/-0.4% vs. 16.5+/-.6%, p=0.009) in 7 patients, with decreases in the sum of the tethering distances (51.2+/-3.9 mm vs. 40.2+/-.1 mm, p=0.034), tenting area (299.2+/-3.8 mm2 vs. 215.0+/-3.6 mm2, p=0.036) and sum of the tenting angles (72.9+/-2.9degreevs. 56.2+/-4.8degree, p=0.015) 6 months after the revascularization.
CONCLUSION
IMR was related with the geometric change in the mitral apparatus. Cardiac MRI can be an effective tool for evaluating these geometric changes and when formulating a treatment plan.

Keyword

Mitral regurgitation; Ischemic heart disease; Magnetic resonance imaging

MeSH Terms

Cardiomyopathy, Dilated
Hemodynamics
Humans
Magnetic Resonance Imaging*
Mitral Valve Insufficiency*
Myocardial Ischemia
Myocardium