J Cardiovasc Ultrasound.  2011 Jun;19(2):69-75. 10.4250/jcu.2011.19.2.69.

Role of Dyssynchrony on Functional Mitral Regurgitation in Patients with Idiopathic Dilated Cardiomyopathy: A Comparison Study with Geometric Parameters of Mitral Apparatus

• Choi WG
• Kim SH
• Park SD
• Baek YS
• Shin SH
• Woo SI
• Kim DH
• Park KS
• Lee WH
• Kwan J

• KMID: 1980354
• DOI: http://doi.org/10.4250/jcu.2011.19.2.69

Abstract

BACKGROUND
Functional mitral regurgitation (FMR) occurs commonly in patients with dilated cardiomyopathy (DCM). This study was conducted to explore the role of left ventricular (LV) dyssynchrony in developing FMR in patients with DCM in comparison with geometric parameters of the mitral apparatus.
METHODS
Twenty patients without FMR and 33 patients with FMR [effective regurgitant orifice area (ERO) = 0.17 +/- 0.10 cm2] were enrolled. MR severity was estimated with ERO area. Dyssynchrony indices (DI) were measured using the standard deviations of time to peak myocardial systolic velocity between eight segments. Using real time 3D echocardiography, mitral valve tenting area (MVTa), anterior (APMD) and posterior papillary muscle distances (PPMD), LV sphericity, and tethering angle of anterior (Aalpha) and posterior leaflets (Palpha) were estimated. All geometrical measurements were corrected (c) by the height of each patient.
RESULTS
The patient with FMR had significantly higher cDI, cMVTa, cAPMD and cPPMD, LV sphericity, Aalpha, and Palpha than the patients without FMR (all p < 0.05). With multiple logistic regression analysis, cMVTa (p = 0.017) found to be strongest predictor of FMR development. In patients with FMR, cMVTa (r = 0.868), cAPMD (r = 0.801), cPPMD (r = 0.742), Aalpha (r = 0.454), LV sphericity (r = 0.452), and DI (r = 0.410) showed significant correlation with ERO. On multivariate regression analysis, cMVTa and cAPMD (p < 0.001, p = 0.022, respectively) remained the strongest determinants of the degree of ERO and cAPMD (p < 0.001) remained the strongest determinant of the degree of cMVTa.
CONCLUSION
Displacement of anterior papillary muscle and consequent mitral valve tenting seem to play a major role in developing FMR in DCM, while LV dyssynchrony seems to have no significant role.

Keyword

Functional mitral regurgitation; Three dimensional echocardiography; Left ventricular dyssynchrony

MeSH Terms

Cardiomyopathy, Dilated
Displacement (Psychology)
Echocardiography, Three-Dimensional
Humans
Logistic Models
Mitral Valve
Mitral Valve Insufficiency
Papillary Muscles

Figure

• 

  Fig. 1 Schematic illustrations explaining geometric parameters of the left ventricle (left) and the mitral apparatus (right). LV: left ventricle, AML: anterior mitral leaflet, PML: posterior mitral leaflet, AP: antero-posterior, CC: commissure-commissure, Aα: tethering angle of anterior leaflet, Pα: tethering angle of posterior leaflet, MVTa: mitral valve tenting area.

• 

  Fig. 2 The distance between the MJAM and the head of each PM was defined as the PM distance. PM: papillary muscle, MJAM: medial junction of the aortic and mitral annuli, PPMD: posterior papillary muscle distance, APMD: anterior papillary muscle distance, APPMD: distance between anterior and posterior papillary muscles.

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