Document Type : Original Article(s)
Authors
- Fereshteh Ghaderi 1
- Farveh Vakilian 2
- Pouya Nezafati 3
- Omid Reza Amini 4
- Mohammad Sobhan Sheikh-Andalibi 5
1 Assistant Professor, Fellowship of Echocardiography, Atherosclerosis Prevention Research Center AND School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Associate Professor, Fellowship of Heart Failure, Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 General Practitioner, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan AND Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
4 Cardiologist, Atherosclerosis Prevention Research Center AND School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
5 Cardiovascular Research Center AND Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract
BACKGROUND: Differentiating ischemic from non-ischemic functional mitral regurgitation (FMR) in patients with cardiomyopathy is important in terms of the therapeutic decision-making and prognosis, but might be clinically challenging. In this study, the deformation of mitral valve (MV) indices in the prediction of the etiology of FMR was assessed using 2D transthoracic and tissue Doppler echocardiography.METHODS: This case-control study was conducted from April 2015 to January 2016 in Imam Reza Hospital in Mashhad, Iran. The participants consisted of 40 patients with ischemic cardiomyopathy (ICM) and 22 with non-ischemic dilated cardiomyopathy (DCM) who referred to the heart failure clinic. Transthoracic echocardiography was performed using the conventional 2D and tissue Doppler imaging (TDI). MV tenting area (TA), coaptation distance (CD), anterior and posterior mitral leaflet angles (AMLA and PMLA), and regional systolic myocardial velocity (Sm) were measured.RESULTS: There were no significant differences in echocardiographic indices between the two groups, besides Sm and PMLA which were significantly lower and higher, respectively, in ICM subjects in comparison with DCM patients (P = 0.002). PMLA ≥ 40 degrees and Sm ≤ 4 cm/second have a relatively high value for discriminating the ischemic from non-ischemic origin of functional MR in subjects with systolic heart failure (sensitivity: 80.0% and 70.0%, specificity: 73.0% and 77.3%; P = 0.001 and P < 0.001; respectively). Multivariable logistic regression identified PMLA and anterior Sm as major determinants for ischemic MR {Odds ratio (OR) [95% confidence interval (CI)] = 0.89 (0.82-0.96), P = 0.003, OR (95% CI) = 0.29 (0.14-0.60), P = 0.001, respectively}.CONCLUSION: The present study showed that PMLA and Sm had an independent significant association with the mechanism of FMR. These findings are suggestive of the predictive role of mitral deformation echocardiographic indices in the determination of the etiology of FMR in systolic heart failure.
Keywords
- Bonow RO, Mann D, Zipes D, Libby P. Braunwald's heart disease: A textbook of cardiovascular medicine, single volume. 9th ed.
- Philadelphia, PA: Saunders; 2015. p. 1479-80.
- Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet 2009; 373(9672): 1382-94.
- Ng AC, Sindone AP, Wong HS, Freedman SB. Differences in management and outcome of ischemic and non-ischemic cardiomyopathy. Int J Cardiol 2008; 129(2): 198-204.
- Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: A quantitative clinical study. Circulation 2000; 102(12): 1400-6.
- Brandt RR, Sperzel J, Pitschner HF, Hamm CW. Echocardiographic assessment of mitral regurgitation in patients with heart failure. Eur Heart J Suppl 2004; 6(suppl_D): D25.
- Nagasaki M, Nishimura S, Ohtaki E, Kasegawa H, Matsumura T, Nagayama M, et al. The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy. Int J Cardiol 2006; 108(2): 171-6.
- Sadeghpour A, Abtahi F, Kiavar M, Esmaeilzadeh M, Samiei N, Ojaghi SZ, et al. Echocardiographic evaluation of mitral geometry in functional mitral regurgitation. J Cardiothorac Surg 2008; 3: 54.
- Donal E, De Place C, Kervio G, Bauer F, Gervais R, Leclercq C, et al. Mitral regurgitation in dilated cardiomyopathy: Value of both regional left ventricular contractility and dyssynchrony. Eur J Echocardiogr 2009; 10(1): 133-8.
- Lesniak-Sobelga A, Wicher-Muniak E, Kostkiewicz M, Olszowska M, Musialek P, Klimeczek P, et al. Relationship between mitral leaflets angles, left ventricular geometry and mitral deformation indices in patients with ischemic mitral regurgitation: Imaging by echocardiography and cardiac magnetic resonance. Int J Cardiovasc Imaging 2012; 28(1): 59-67.
- Konstantinou DM, Papadopoulou K, Giannakoulas G, Kamperidis V, Dalamanga EG, Damvopoulou E, et al. Determinants of functional mitral regurgitation severity in patients with ischemic cardiomyopathy versus nonischemic dilated cardiomyopathy. Echocardiography 2014; 31(1): 21-8.
- Papadopoulou K, Giannakoulas G, Karvounis H, Dalamanga E, Karamitsos T, Parcharidou D, et al. Differences in echocardiographic characteristics of functional mitral regurgitation in ischaemic versus idiopathic dilated cardiomyopathy: A pilot study. Hellenic J Cardiol 2009; 50(1): 37-44.
- Karaca O, Avci A, Guler GB, Alizade E, Guler E, Gecmen C, et al. Tenting area reflects disease severity and prognosis in patients with non-ischaemic dilated cardiomyopathy and functional mitral regurgitation. Eur J Heart Fail 2011; 13(3): 284-91.
- Watanabe N, Ogasawara Y, Yamaura Y, Kawamoto T, Toyota E, Akasaka T, et al. Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography. J Am Coll Cardiol 2005; 45(5): 763-9.
- Levine RA, Hagege AA, Judge DP, Padala M, Dal-Bianco JP, Aikawa E, et al. Mitral valve disease-morphology and mechanisms. Nat Rev Cardiol 2015; 12(12): 689-710.
- Otsuji Y, Levine RA, Takeuchi M, Sakata R, Tei C. Mechanism of ischemic mitral regurgitation. J Cardiol 2008; 51(3): 145-56.
- Gillam LD. Is it time to update the definition of functional mitral regurgitation?: Structural changes in the mitral leaflets with left ventricular dysfunction. Circulation 2008; 118(8): 797-9.
- Gorman JH 3rd, Gorman RC, Plappert T, Jackson BM, Hiramatsu Y, St John-Sutton MG, et al. Infarct size and location determine development of mitral regurgitation in the sheep model. J Thorac Cardiovasc Surg 1998; 115(3): 615-22.
- Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Senechal M. Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation 2007; 115(6): 782-91.
)