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European Journal of Echocardiography 2007 8(3):195-203; doi:10.1016/j.euje.2006.03.002
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Copyright © 2006, The European Society of Cardiology

Geometric predictor of significant mitral regurgitation in patients with severe ischemic cardiomyopathy, undergoing Dor procedure: A real-time 3D echocardiographic study

Jun Kwana,*, Marc A. Gillinovc, James D. Thomasb and Takahiro Shiotab

aDepartment of Cardiology, Inha University Hospital, 7-206, 3-Ga, Shinheung-Dong, Jung-Gu, Inchon 400-711, Republic of Korea
bCardiovascular Imaging Center, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH, USA
cDepartment of Cardiac Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA

Received 24 November 2005; received in revised form 26 February 2006; accepted after revision 2 March 2006.

* Corresponding author. Tel.: +8232 890 2453; fax: +8232 890 2447. kuonmd{at}inha.ac.kr


  Abstract

Background and purpose Significant mitral regurgitation (MR) is frequently associated with coronary artery disease. The precise geometric predictors of significant MR in ischemic cardiomyopathy are not clearly defined. We performed real-time 3D echocardiography (RT3DE) in 48 patients scheduled for infarct exclusion surgery or Dor procedure, 22 of whom had moderate or severe MR (DorMR) and 26 with no or trivial MR (DorNoMR).

Methods Two orthogonal apical volumetric planes of LV, commissure–commissure (CC) and antero-posterior (AP) planes, were generated during mid-systole. Mitral valve tenting height (MVTht) and area (MVTa) were measured. The degree of leaflet tethering was estimated by the angles between the annular plane and each leaflet (anterior leaflet: A{alpha}, posterior leaflet: P{alpha}).

Results MVTht (1.11±0.14 vs 0.78±0.20cm, P<0.01) and MVTa (1.30±0.34 vs 0.87±0.27cm2, P<0.01) were significantly larger in DorMR compared with DorNoMR. In DorMR, both A{alpha} (38±6 vs 31±7°, P<0.01) and P{alpha} (60±7 vs 41±8°, P<0.01) significantly increased more than those in DorNoMR. Multiple logistic regression analysis found P{alpha} to be the most important geometric predictor of significant MR. MV tenting area was found to be the strongest determinant of MR severity in ischemic cardiomyopathy patients with significant MR by multivariate linear regression analysis.

Conclusions Detecting significant posterior leaflet tethering, the most important predictor of significant MR, and measuring MV tenting area, the strongest determinant of MR severity, using RT3DE may be helpful in decision making of additive surgical intervention for MR in patients with severe ischemic cardiomyopathy.

Keywords: Cardiomyopathy; Mitral valve; Echocardiography


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