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Hasegawa H, Kuwajima K, Kagawa S, Yamane T, Rader F, Siegel RJ, Shiota T. Impact of eccentric jet on outcomes in patients with atrial functional mitral regurgitation: An echocardiographic study. Int J Cardiol 2023; 391:131342. [PMID: 37678430 DOI: 10.1016/j.ijcard.2023.131342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/17/2023] [Accepted: 09/03/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Previous studies have reported the mechanisms underlying atrial functional mitral regurgitation (A-FMR). Recently, A-FMR subtypes based on mitral regurgitation (MR) mechanisms were proposed: "central jet" due to insufficient leaflet remodeling and "eccentric jet" due to atriogenic tethering. However, their prognostic value remains unclear. Therefore, this study investigated the impact of A-FMR subtypes on clinical outcomes. METHODS Outpatients with significant A-FMR between January 2013 and December 2016 were retrospectively reviewed. They were classified into two subtypes according to the MR jet's direction. All-cause mortality, heart failure hospitalization, and any mitral valve interventions were the primary composite endpoint. RESULTS Among 101 patients with significant A-FMR, 32% had eccentric jet. The primary endpoint was observed in 56 patients during the follow-up period (median 0.7 years, range 0.1-4.2 years). Kaplan-Meier curves demonstrated that the composite endpoint was higher among patients with eccentric jet than those with central jet (log-rank p < 0.001). Eccentric jet (hazard ratio [HR] 2.46, 95% confidence interval [CI] 1.28-4.73; p = 0.007), age (HR 1.06, 95% CI 1.02-1.11; p = 0.002), symptoms (HR 6.22, 95% CI 2.18-17.8; p < 0.001), severe MR (HR 3.97, 95% CI 1.92-8.18; p < 0.001), and significant tricuspid regurgitation (TR; HR 2.00, 95% CI 1.01-3.97; p = 0.047) were independent predictors of the composite endpoint. CONCLUSIONS Patients with eccentric jet had poorer outcomes than those with central jet. Eccentric jet, age, symptoms, severe MR, and significant TR were independently associated with poor outcomes.
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Affiliation(s)
- Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Differences in clinical and echocardiographic features and outcomes between atrial functional mitral regurgitation patients with and without posterior mitral leaflet bending. J Cardiol 2023:S0914-5087(23)00023-0. [PMID: 36764515 DOI: 10.1016/j.jjcc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/24/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Posterior mitral leaflet (PML) bending is a cause of atrial functional mitral regurgitation (AFMR). We aimed to investigate differences in clinical and echocardiographic features and outcomes between AFMR patients with and without PML bending. METHODS We retrospectively examined 118 AFMR patients with atrial fibrillation (AF), mild or greater MR without degenerative mitral valve changes, and left ventricular ejection fraction ≥50 %. Patients were classified by the presence of PML bending: PML bending (n=24) and no PML bending (n=94). PML bending was defined as PML-to-anterior mitral leaflet angle ratio ≥3.1 calculated using receiver operating characteristics analysis for eccentric MR jet toward left atrial posterior wall. The study endpoint was a composite of cardiac death, admission for heart failure, and mitral valve surgery. RESULTS Overall, a total of 88 patients (75 %) had mild MR. There were no between-group differences in clinical and echocardiographic characteristics including AF duration and cardiac cavities size except for the length of inward bending of the left ventricular posterobasal wall and the mitral annular area. The 36-month event-free survival for the composite endpoint was significantly lower in the PML bending group (63 % vs. 78 %; Log-rank p=0.047). In multivariate analysis, PML bending was also associated with the composite outcome. CONCLUSIONS AFMR patients with PML bending may have worse outcomes than those without PML bending despite similar clinical features.
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Impact of asymmetric tethering on outcomes after edge-to-edge mitral valve repair for secondary mitral regurgitation. Clin Res Cardiol 2021; 111:869-880. [PMID: 34786592 PMCID: PMC9334427 DOI: 10.1007/s00392-021-01961-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/22/2021] [Indexed: 02/07/2023]
Abstract
Background The impact of postero-anterior and medio-lateral mitral valve (MV) tethering patterns on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for secondary mitral regurgitation (SMR) is unknown. Methods The ratio of the posterior to anterior MV leaflet angle (PLA/ALA) in MV segment 2 was defined as postero-anterior tethering asymmetry. Medio-lateral tethering asymmetry was assessed as the ratio of the medial (segment 3) to lateral (segment 1) MV tenting area. We used receiver-operating characteristics and a Cox regression model to identify cut-off values of asymmetric anteroposterior and medio-lateral tethering for prediction of 2 year all-cause mortality after TMVR. Results Among 178 SMR patients, postero-anterior tethering was asymmetric in 67 patients (37.9%, PLA/ALA ratio > 1.54). Asymmetric medio-lateral tethering (tenting area ratio > 1.49) was observed in 49 patients (27.5%). M-TEER reduced MR to ≤ 2 + in 92.1% of patients; MR reduction was less effective in the presence of asymmetric postero-anterior tethering (p = 0.02). A multivariable Cox regression model identified both types of asymmetric MV tethering to be associated with increased all-cause 2-year mortality (postero-anterior tethering asymmetry: HR = 2.77, CI 1.43–5.38; medio-lateral tethering asymmetry: HR = 2.90, CI 1.54–5.45; p < 0.01). Conclusions Asymmetric postero-anterior and medio-lateral MV tethering patterns are associated with increased 2-year mortality in patients undergoing M-TEER for SMR. A detailed echocardiographic analysis of MV anatomy may help to identify patients who profit most from M-TEER.
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Supplementary Information The online version contains supplementary material available at 10.1007/s00392-021-01961-5.
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Salvatore T, Ricci F, Dangas GD, Rana BS, Ceriello L, Testa L, Khanji MY, Caterino AL, Fiore C, Popolo Rubbio A, Appignani M, Di Fulvio M, Bedogni F, Gallina S, Zimarino M. Selection of the Optimal Candidate to MitraClip for Secondary Mitral Regurgitation: Beyond Mitral Valve Morphology. Front Cardiovasc Med 2021; 8:585415. [PMID: 33614745 PMCID: PMC7887290 DOI: 10.3389/fcvm.2021.585415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Secondary mitral regurgitation (MR) occurs despite structurally normal valve apparatus due to an underlying disease of the myocardium leading to disruption of the balance between tethering and closing forces with ensuing failure of leaflet coaptation. In patients with heart failure (HF) and left ventricular dysfunction, secondary MR is independently associated with poor outcome, yet prognostic benefits related to the correction of MR have remained elusive. Surgery is not recommended for the correction of secondary MR outside coronary artery bypass grafting. Percutaneous mitral valve repair (PMVR) with MitraClip implantation has recently evolved as a new transcatheter treatment option of inoperable or high-risk patients with severe MR, with promising results supporting the extension of guideline recommendations. MitraClip is highly effective in reducing secondary MR in HF patients. However, the derived clinical benefit is still controversial as two randomized trials directly comparing PMVR vs. optimal medical therapy in severe secondary MR yielded virtually opposite conclusions. We reviewed current evidence to identify predictors of PMVR-related outcomes in secondary MR useful to improve the timing and the selection of patients who would derive maximal benefit from MitraClip intervention. Beyond mitral valve anatomy, optimal candidate selection should rely on a comprehensive diagnostic workup and a fine-tuned risk stratification process aimed at (i) recognizing the substantial heterogeneity of secondary MR and its complex interaction with the myocardium, (ii) foreseeing hemodynamic consequences of PMVR, (iii) anticipating futility and (iv) improving symptoms, quality of life and overall survival.
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Affiliation(s)
- Tanya Salvatore
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Fabrizio Ricci
- Department of Clinical Sciences, Clinical Research Center, Lund University, Malmö, Sweden.,Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Casa di Cura Villa Serena, Città Sant'Angelo, Pescara, Italy
| | - George D Dangas
- Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, New York, NY, United States
| | - Bushra S Rana
- Imperial College Healthcare Trust, Hammersmith and Charing Cross Hospitals, London, United Kingdom
| | - Laura Ceriello
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Mohammed Y Khanji
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Anna Laura Caterino
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | | | - Marianna Appignani
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Maria Di Fulvio
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Pol. S. Donato, S. Donato Milanese, Milan, Italy
| | - Sabina Gallina
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Zimarino
- Institute of Cardiology, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Interventional Cath Lab, Chieti, Italy
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Ischemic functional mitral regurgitation: from pathophysiological concepts to current treatment options. A systemic review for optimal strategy. Gen Thorac Cardiovasc Surg 2021; 69:213-229. [PMID: 33400198 DOI: 10.1007/s11748-020-01562-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/24/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The current treatment of ischemic functional mitral regurgitation (FMR) remains debated due to differences in inclusion criteria of randomized studies and baseline characteristics. Also, the role of left ventricular pathophysiology and the role of subvalvular apparatus have not been thoroughly investigated in recent literature. METHODS A literature search was performed from PubMed inception to June 2020. RESULTS Novel concepts of pathophysiology, such as the proportionate/disproportionate conceptual framework, the role of papillary muscles and left ventricular dysfunction, the impact of myocardial ischemia and revascularization, left ventricular remodeling, and the effect of restrictive annuloplasty or subvalvular procedures have been reviewed. CONCLUSIONS The clinical benefits associated with the use of MitraClip is more evident in patients with disproportionate FMR with greater and sustained left ventricular reverse remodeling. Importantly, in the absence of myocardial revascularization, expansion of myocardial scar tissue and non-perfused areas of ischemic myocardium occur with time, and this impact on outcomes with a longer follow-up period cannot be quantified. In advanced phases of FMR, neither mitral ring annuloplasty nor percutaneous therapies could significantly modify the established pathoanatomic alterations.
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Ricci F, Aung N, Gallina S, Zemrak F, Fung K, Bisaccia G, Paiva JM, Khanji MY, Mantini C, Palermi S, Lee AM, Piechnik SK, Neubauer S, Petersen SE. Cardiovascular magnetic resonance reference values of mitral and tricuspid annular dimensions: the UK Biobank cohort. J Cardiovasc Magn Reson 2020; 23:5. [PMID: 33407573 PMCID: PMC7788733 DOI: 10.1186/s12968-020-00688-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Mitral valve (MV) and tricuspid valve (TV) apparatus geometry are essential to define mechanisms and etiologies of regurgitation and to inform surgical or transcatheter interventions. Given the increasing use of cardiovascular magnetic resonance (CMR) for the evaluation of valvular heart disease, we aimed to establish CMR-derived age- and sex-specific reference values for mitral annular (MA) and tricuspid annular (TA) dimensions and tethering indices derived from truly healthy Caucasian adults. METHODS 5065 consecutive UK Biobank participants underwent CMR using cine balanced steady-state free precession imaging at 1.5 T. Participants with non-Caucasian ethnicity, prevalent cardiovascular disease and other conditions known to affect cardiac chamber size and function were excluded. Absolute and indexed reference ranges for MA and TA diameters and tethering indices were stratified by gender and age (45-54, 55-64, 65-74 years). RESULTS Overall, 721 (14.2%) truly healthy participants aged 45-74 years (54% women) formed the reference cohort. Absolute MA and TA diameters, MV tenting length and MV tenting area, were significantly larger in men. Mean ± standard deviation (SD) end-diastolic and end-systolic MA diameters in the 3-chamber view (anteroposterior diameter) were 2.9 ± 0.4 cm (1.5 ± 0.2 cm/m2) and 3.3 ± 0.4 cm (1.7 ± 0.2 cm/m2) in men, and 2.6 ± 0.4 cm (1.6 ± 0.2 cm/m2) and 3.0 ± 0.4 cm (1.8 ± 0.2 cm/m2) in women, respectively. Mean ± SD end-diastolic and end-systolic TA diameters in the 4-chamber view were 3.2 ± 0.5 cm (1.6 ± 0.3 cm/m2) and 3.2 ± 0.5 cm (1.7 ± 0.3 cm/m2) in men, and 2.9 ± 0.4 cm (1.7 ± 0.2 cm/m2) and 2.8 ± 0.4 cm (1.7 ± 0.3 cm/m2) in women, respectively. With advancing age, end-diastolic TA diameter became larger and posterior MV leaflet angle smaller in both sexes. Reproducibility of measurements was good to excellent with an inter-rater intraclass correlation coefficient (ICC) between 0.92 and 0.98 and an intra-rater ICC between 0.90 and 0.97. CONCLUSIONS We described age- and sex-specific reference ranges of MA and TA dimensions and tethering indices in the largest validated healthy Caucasian population. Reference ranges presented in this study may help to improve the distinction between normal and pathological states, prompting the identification of subjects that may benefit from advanced cardiac imaging for annular sizing and planning of valvular interventions.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Casa Di Cura Villa Serena, 65013, Città Sant'Angelo, Pescara, Italy
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Filip Zemrak
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Giandomenico Bisaccia
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Stefano Palermi
- Department of Neuroscience, Imaging and Clinical Sciences, "G.D'Annunzio" University, Chieti, Italy
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Stefan K Piechnik
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, NIHR BRC Oxford, Radcliffe Department of Medicine, University of Oxford, Level 6, West Wing, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK.
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK.
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Mihos CG, Yucel E, Upadhyay GA, Orencole MP, Singh JP, Picard MH. Left ventricle and mitral valve reverse remodeling in response to cardiac resynchronization therapy in nonischemic cardiomyopathy. Echocardiography 2020; 37:1557-1565. [PMID: 32914427 DOI: 10.1111/echo.14844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/23/2020] [Accepted: 08/12/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves left heart geometry and function in nonischemic cardiomyopathy (NICMP). We aimed to detail the effects of CRT on left ventricular (LV) and mitral valve (MV) remodeling using 2-dimensional transthoracic echocardiography. METHODS Forty-five consecutive patients with NICMP who underwent CRT implantation between 2009 and 2012, and had pre-CRT and follow-up echocardiograms available, were included. Paired t test, linear and logistic regression, and Kaplan-Meier survival analyses were used for statistical assessment. RESULTS The mean age and QRS duration were 60 years and 157 ms, respectively, and 13 (28.9%) were female. At a mean follow-up of 3 years, there were 22 (48.9%) "CRT responders" (≥15% reduction in LV end-systolic volume index [LVESVi]). Significant improvements were observed in LV ejection fraction (26.3% vs 34.3%) and LVESVi (87.7 vs 71.1 mL/m2 ), as well as mitral regurgitation vena contracta width, MV tenting height and area, and end-systolic interpapillary muscle distance. Five-year actuarial survival was 87.5%. Multivariate regression analyses revealed the pre-CRT LVESVi (β = 0.52), and MV coaptation length (β = -0.34) and septolateral annular diameter (β = 0.25) as good correlates of follow-up LVESVi. Variables associated with CRT response were pre-CRT MV coaptation length (OR 1.75, 95% CI 1.0-3.1) and posterior leaflet tethering angle (OR 1.07, 95% CI 1.0-1.14), irrespective of baseline QRS morphology and duration (all P < .05). CONCLUSIONS Cardiac resynchronization therapy improves LV and MV geometry and function in half of patients with NICMP, which is paralleled by decreased mitral regurgitation severity. The extent of pre-CRT LV remodeling and MV tethering are associated with CRT response.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida, USA.,Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Mary P Orencole
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jagmeet P Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael H Picard
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Hübscher A, Schwerg M, Hoffmann S, Baldenhofer G, Heupel C, Jasaityte R, Kruck S, Stangl K, Dreger H, Knebel F. Automated quantification of mitral valve tenting volume in functional mitral regurgitation by three‐dimensional echocardiography. Echocardiography 2020; 37:1043-1048. [DOI: 10.1111/echo.14759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/24/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Anne Hübscher
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Marius Schwerg
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Saskia Hoffmann
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Gerd Baldenhofer
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Christian Heupel
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Ruta Jasaityte
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
| | - Sebastian Kruck
- Cardio Centrum Ludwigsburg Bietigheim Bietigheim‐Bissingen Germany
| | - Karl Stangl
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Henryk Dreger
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
| | - Fabian Knebel
- Medizinische Klinik für Kardiologie und AngiologieCampus Charité MitteCharité – Universitätsmedizin Berlin Berlin Germany
- DZHK (German Centre for Cardiovascular Research)Partner Site Berlin Germany
- Berlin Institute of Health (BIH) Berlin Germany
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Saidova MA, Andrianova AM. [Ischemic Mitral Regurgitation: Echocardiographic Algorithm, the Place of Three-Dimensional Transesophageal Echocardiography]. ACTA ACUST UNITED AC 2020; 60:54-60. [PMID: 32345199 DOI: 10.18087/cardio.2020.2.n839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022]
Abstract
Objective Identify the diagnostic markers of the severe MV changes in patients with ischemic mitral regurgitation (IMR) and suggest a modification of the echocardiography (EchoCG) algorithm.Materials and Methods A two-stage examination of 65 patients with mild (n=22), moderate (n=22), and severe (n=21) IMR was performed using two-dimensional (2D) transthoracic EchoCG with dopplerography, 2D and three-dimensional (3D) transesophageal EchoCG (TEE). 4D MV-Assessment in off-line mode was made in TomTec Imaging Systems GmbH, Germany. Statistical analysis (SAS 9.4) included Student's t-test, Kruskal-Wallis method, Pearson correlation, multivariate regression analysis, and ROC-analysis.Results According to 3D TEE the significant changes in MV annulus, leaflets and tenting are detected. 3D parameters of MV geometry are related to IMR severity, left ventricle (LV) remodeling (global and regional), and they are different in symmetric and asymmetric variants. In symmetric variant MV reconstruction is correlated with LV dilatation and contractility decrease, in asymmetric variant it's correlated with regional remodeling parameters. Severe IMR is characterized by a decrease in MV annulus displacement (27,0±6,6 mm/s versus 32,4±10,8 mm/s in mild IMR; р<0,05), tenting volume fraction (32,5±14,8% versus 56,2±16,8% in mild IMR; p<0,05), and annulus area fraction (4,7±2,7% versus 6,6±4,5% in mild IMR; р<0,05). Vena contracta width (VCW), Proximal Isovelocity Surface Area (PISA) radius, Effective Regurgitant Orifice Area (EROA), Regurgitant Volume (Rvol), LV end systolic dimension (LV ESD), and central large jet >50% of left atrium (LA) area have a predictive value in the diagnosis of MV geometry severe changes. If thresholds are reached these 2D TTE parameters can be used as indications for the 3D TEE.Conclusion 3D TEE allows for detailed assessment of MV geometry and function depended on IMR severity and variant. To make decision of MV surgery 3D TEE is recommended if the following indicators are presented: (1) VCW ≥0,7 cm; PISA radius ≥1,0 cm; central large jet >50% of LA area; LV ESD ≥4,0 cm; (2) VCW ≥0,6 cm; PISA radius = 0,6-0,99 cm; EROA ≥0,3 cm2; RVol≥45 cm; IMR eccentric jet + IMR elliptical orifice.
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Affiliation(s)
- M A Saidova
- National Medical Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A M Andrianova
- National Medical Research Center for Cardiology of the Ministry of Health of the Russian Federation, Moscow, Russia
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Risk of Ischemic Mitral Regurgitation Recurrence After Combined Valvular and Subvalvular Repair. Ann Thorac Surg 2019; 108:536-543. [PMID: 30684477 DOI: 10.1016/j.athoracsur.2018.12.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mitral valve repair (MVr) combined with papillary muscle approximation (PMA) may improve repair durability in severe ischemic mitral regurgitation (MR), when compared with MVr alone. We sought to identify preoperative transthoracic echocardiographic markers associated with MR recurrence after MVr with PMA. METHODS A post-hoc analysis was performed on patients with severe ischemic MR who underwent coronary artery bypass graft surgery with MVr with PMA in the papillary muscle approximation randomized trial. The PMA was performed utilizing a 4-mm polytetrafluoroethylene graft placed around the papillary muscles. Linear regression analyses and receiver-operating characteristic curves were used to identify echocardiographic variables and diagnostic models associated with recurrent MR. RESULTS There were 48 patients with a mean age of 63 ± 7 years, a left ventricular ejection fraction of 35% ± 5%, and a left ventricular end-diastolic diameter of 63 ± 3 mm. Of these, 37 patients had baseline and 5-year follow-up echocardiograms, with moderate-to-severe MR recurring in 27%. Linear regression analyses revealed associations between preoperative pulmonary artery systolic pressure (standardized beta coefficient, β = 0.49/mm Hg, p = 0.002), MV tenting area (β = 0.47/cm2, p = 0.004), a symmetric MV tethering pattern (β = 0.44, p = 0.007), and left ventricular end-diastolic diameter (β = 0.37/mm, p = 0.02) with follow-up MR grade. The presence of both MV tenting area 3.1 cm2 or greater (area under the curve 0.822) and left ventricular end-diastolic diameter of 64 mm or greater (area under the curve 0.801) was the most robust discriminative model for moderate-to-severe MR recurrence (specificity 92%, sensitivity 69%, area under the curve 0.804, p = 0.003). CONCLUSIONS In patients undergoing coronary artery bypass graft surgery with MVr plus PMA, the extent of baseline MV apparatus and left ventricle geometric remodeling identifies patients at increased risk for MR recurrence.
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11
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Dal-Bianco JP, Bartko PE, Levine RA. Anticipating the Vicious Circle of Postinfarction Mitral Regurgitation: Imaging Insights. Circ Cardiovasc Imaging 2018; 9:CIRCIMAGING.116.005070. [PMID: 27406845 DOI: 10.1161/circimaging.116.005070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Philipp E Bartko
- From the Massachusetts General Hospital, Harvard Medical School, Boston
| | - Robert A Levine
- From the Massachusetts General Hospital, Harvard Medical School, Boston.
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12
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Utsunomiya H, Itabashi Y, Kobayashi S, Yoshida J, Ikenaga H, Rader F, Hussaini A, Makar M, Trento A, Siegel RJ, Kar S, Shiota T. Comparison of mitral valve geometrical effect of percutaneous edge-to-edge repair between central and eccentric functional mitral regurgitation: clinical implications. Eur Heart J Cardiovasc Imaging 2018; 20:455-466. [DOI: 10.1093/ehjci/jey117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/01/2018] [Accepted: 07/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Hiroto Utsunomiya
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Yuji Itabashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Sayuki Kobayashi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Jun Yoshida
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Hiroki Ikenaga
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Florian Rader
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Asma Hussaini
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Alfredo Trento
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Robert J Siegel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Saibal Kar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd. A3411, Los Angeles, CA, USA
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13
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Nappi F, Avatar Singh SS, Santana O, Mihos CG. Functional mitral regurgitation: an overview for surgical management framework. J Thorac Dis 2018; 10:4540-4555. [PMID: 30174907 DOI: 10.21037/jtd.2018.07.07] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Functional mitral regurgitation (FMR) is one the most common complications of myocardial infarction (MI) in adults carrying a significant clinical and economic burden. Despite specific randomized controlled studies to address its treatment have been performed, there are still a number of questions remained unanswered. Outcomes of surgical repair of FMR are still hampered by a significant rate of recurrence of regurgitation and need for reoperation. Mechanisms underlying failure of repairs still need to be completely clarified and questions regarding the indications and optimal timing for intervention as well as the best suitable operative technique to be applied are still debated. This work will review the current knowledge on FMR including its pathogenic mechanisms, the available treatment strategies, the evidences from trials and observational studies and the potential future directions to address the issues related to its treatment.
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Affiliation(s)
| | | | - Orlando Santana
- Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL, USA
| | - Christos G Mihos
- Division of Cardiology, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL, USA
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14
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Morbach C, Bellavia D, Störk S, Sugeng L. Systolic characteristics and dynamic changes of the mitral valve in different grades of ischemic mitral regurgitation - insights from 3D transesophageal echocardiography. BMC Cardiovasc Disord 2018; 18:93. [PMID: 29747569 PMCID: PMC5946441 DOI: 10.1186/s12872-018-0819-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitral regurgitation in ischemic heart disease (IMR) is a strong predictor of outcome but until now, pathophysiology is not sufficiently understood and treatment is not satisfying. We aimed to systematically evaluate structural and functional mitral valve leaflet and annular characteristics in patients with IMR to determine the differences in geometric and dynamic changes of the MV between significant and mild IMR. METHODS Thirty-seven patients with IMR (18 mild (m)MR, 19 significant (moderate+severe) (s)MR) and 33 controls underwent TEE. 3D volumes were analyzed using 3D feature-tracking software. RESULTS All IMR patients showed a loss of mitral annular motility and non-planarity, whereas mitral annulus dilation and leaflet enlargement occurred in sMR only. Active-posterior-leaflet-area decreased in early systole in all three groups accompanied by an increase in active-anterior-leaflet-area in early systole in controls and mMR but only in late systole in sMR. CONCLUSIONS In addition to a significant enlargement and loss in motility of the MV annulus, patients with significant IMR showed a spatio-temporal alteration of the mitral valve coaptation line due to a delayed increase in active-anterior-leaflet-area. This abnormality is likely to contribute to IMR severity and is worth the evaluation of becoming a parameter for clinical decision-making. Further, addressing the leaflets aiming to increase the active leaflet-area is a promising therapeutic approach for significant IMR. Additional studies with a larger sample size and post-operative assessment are warranted to further validate our findings and help understand the dynamics of the mitral valve.
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Affiliation(s)
- Caroline Morbach
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.,Comprehensive Heart Failure Center and Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Diego Bellavia
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.,Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IRCCS-ISMETT), Palermo, Italy
| | - Stefan Störk
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University of Würzburg, Würzburg, Germany
| | - Lissa Sugeng
- Yale School of Medicine, Section Cardiovascular Medicine, 330 Cedar Street, P.O Box 208017, New Haven, CT, 06511, USA.
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15
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Antonini-Canterin F, Faganello G, Mantero A, Citro R, Colonna P, Giorgi M, Manuppelli V, Monte I, Petrella L, Posteraro A, Di Bello V, Carerj S, Benedetto F. Cardiovascular Multimodality Imaging: It is Time to Get on Board! A "Società Italiana di Ecocardiografia e CardioVascular Imaging" Statement. J Cardiovasc Echogr 2018; 28:1-8. [PMID: 29629253 PMCID: PMC5875130 DOI: 10.4103/jcecho.jcecho_66_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Francesco Antonini-Canterin
- Ospedale Riabilitativo di Alta Specializzazione, Unità Operativa di Cardiologia Riabilitativa e Preventiva, Motta di Livenza, Italy
| | - Giorgio Faganello
- Cardiovascular Center, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Antonio Mantero
- Società Italiana di Ecocardiografia e CardioVascular Imaging, Milano, Italy
| | - Rodolfo Citro
- Department of Cardiology, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Paolo Colonna
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
| | - Mauro Giorgi
- Department of Torino Cardiovascular, San Giovanni Battista Hospital, Torino, Italy
| | | | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Licia Petrella
- Department of Cardiac Surgery, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Alfredo Posteraro
- Medical Department, Cardiology Unit, Presidio Ospedaliero Integrato Portuense, Roma, Italy
| | | | - Scipione Carerj
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Frank Benedetto
- Unità Operativa Complessa, Clinical and Rehabilitation Cardiology, Reggio Calabria, Italy
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16
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Mihos CG, Yucel E, Capoulade R, Orencole MP, Upadhyay GA, Santana O, Singh JP, Picard MH. Effects of cardiac resynchronization therapy after inferior myocardial infarction on secondary mitral regurgitation and mitral valve geometry. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:114-121. [DOI: 10.1111/pace.13255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/06/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Christos G. Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Romain Capoulade
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Mary P. Orencole
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | | | - Orlando Santana
- Echocardiography Laboratory, Columbia University Division of Cardiology; Mount Sinai Heart Institute; Miami Beach FL USA
| | - Jagmeet P. Singh
- Cardiac Arrhythmia Service, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital; Harvard Medical School; Boston MA USA
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17
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Abstract
PURPOSE OF REVIEW Three-dimensional (3D) echocardiography (3DE) and 4-dimensional echocardiography (4DE), also known as real-time (RT) 3DE (RT3DE), are rapidly emerging technologies which have made significant impact in the clinical arena over the years. This review will discuss the recent applications of 3DE in diagnosing and treating different types of cardiovascular disease. RECENT FINDINGS Recent studies using 3DE expanded on prior findings and introduced additional applications to different cardiac conditions. Some studies have used 3D parameters to prognosticate long-term outcomes. Numerous innovative software designs including fully automated algorithms have been introduced to better evaluate valvular heart disease and cardiac function. SUMMARY With further evolution of 3DE technologies, this imaging modality will emerge as a powerful tool and likely become the imaging modality of choice in the diagnosis and management of various cardiac disorders.
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Affiliation(s)
- Susan H. Kwon
- Research Department, 100 Port Washington Blvd, Roslyn, NY 11576 USA
| | - Aasha S. Gopal
- Research Department, 100 Port Washington Blvd, Roslyn, NY 11576 USA
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18
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Faletra FF, Berrebi A, Pedrazzini G, Leo LA, Paiocchi VL, Cautilli G, Casso G, Cassina T, Moccetti T, Malouf JF. 3D transesophageal echocardiography: A new imaging tool for assessment of mitral regurgitation and for guiding percutaneous edge-to-edge mitral valve repair. Prog Cardiovasc Dis 2017; 60:305-321. [DOI: 10.1016/j.pcad.2017.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/15/2017] [Indexed: 12/17/2022]
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19
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Yoshida S, Fukushima S, Miyagawa S, Nakamura T, Yoshikawa Y, Hata H, Saito S, Yoshioka D, Domae K, Kashiyama N, Yamamoto K, Shintani A, Nakatani S, Toda K, Sawa Y. Mitral Valve Structure in Addition to Myocardial Viability Determines the Outcome of Functional Mitral Regurgitation After Coronary Artery Bypass Grafting. Circ J 2017. [PMID: 28626146 DOI: 10.1253/circj.cj-16-1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) reduces functional mitral regurgitation (MR) associated with ischemic heart disease, although the predictive factors or mechanisms of reversibility of functional MR after CABG are not fully understood.We investigated whether mitral valve structure is associated with the outcome of functional MR after CABG.Methods and Results:From a consecutive series of 98 patients with mild-moderate functional MR preoperatively who underwent isolated CABG, we enrolled 66 patients who were followed up for >1 year postoperatively using echocardiography. The degree of MR was reduced in 34 patients (52%) postoperatively, in association with a lower rate of in-hospital treatment for cardiac failure in the long term, compared with the 32 patients (48%) with residual MR postoperatively. The patients with reduced MR postoperatively had longer estimated coaptation length and more anteriorly or centrally directed MR jets than those without reduced MR. On statistical analysis, the addition of estimated coaptation length and jet direction to the reported predictors (ejection fraction, left ventricular end-diastolic dimension, and tenting height) more accurately predicted changes in post-CABG MR than the reported 3 factors alone. CONCLUSIONS Residual MR was associated with the emergence of congestive heart failure in the long term after CABG. A specific mitral valve structure, such as large mitral leaflet size or predominant tethering of the posterior leaflet, was a predictive factor for the reversibility of post-CABG functional MR.
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Affiliation(s)
- Shohei Yoshida
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Teruya Nakamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Shunsuke Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Keitaro Domae
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Noriyuki Kashiyama
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kouji Yamamoto
- Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine
| | - Ayumi Shintani
- Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine
| | - Satoshi Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
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20
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Valooran GJ, Nair SK, Sebastian R. Surgical management of ischemic mitral regurgitation. Indian J Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s12055-017-0511-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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21
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Berdejo J, Shiota M, Mihara H, Itabashi Y, Utsunomiya H, Shiota T. Vena contracta analysis by color Doppler three-dimensional transesophageal echocardiography shows geometrical differences between prolapse and pseudoprolapse in eccentric mitral regurgitation. Echocardiography 2017; 34:683-689. [PMID: 28317206 DOI: 10.1111/echo.13508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS Evaluation of eccentric mitral regurgitation (MR) remains extremely difficult and the role played by its etiology, functional or degenerative, is not well understood. This study aimed to demonstrate the value of three-dimensional transesophageal echocardiography (3DTEE) in the evaluation of eccentric MR identifying geometric differences in the vena contracta area between functional and degenerative etiologies. METHODS AND RESULTS We studied 61 patients with eccentric MR (30 functional and 31 degenerative). Regurgitant orifice area was determined by the two-dimensional proximal isovelocity surface area (2DPISA) and the 3DTEE methods. The ratio between maximum and minimum lengths of the vena contracta was calculated in each patient. Effective regurgitant orifice area by the 2DPISA method was smaller than that estimated by 3DTEE (0.56±0.21 vs 0.72±0.25 cm2 ). A better correlation between both methods was seen in degenerative mitral regurgitation (DMR; r=.83), with a mean underestimation of 8.2% by the 2DPISA method. A much worse correlation was found in functional mitral regurgitation (FMR; r=.39), where a mean underestimation by the 2DPISA method of 29.1% was observed. There was a more elongated and curved vena contracta in FMR compared to that in DMR (length ratio: 3.4±1.0 vs 2.2±0.7, P<.0001). CONCLUSION Three-dimensional transesophageal echocardiography identifies a more elongated regurgitant orifice in eccentric FMR compared to that in eccentric DMR. This difference may explain the greater underestimation of effective regurgitant orifice area by the 2DPISA method in FMR. High-quality 3DTEE analysis of vena contracta area would be a highly recommended alternative.
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Affiliation(s)
| | - Maiko Shiota
- Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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22
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Nappi F, Spadaccio C, Nenna A, Lusini M, Fraldi M, Acar C, Chello M. Is subvalvular repair worthwhile in severe ischemic mitral regurgitation? Subanalysis of the Papillary Muscle Approximation trial. J Thorac Cardiovasc Surg 2016; 153:286-295.e2. [PMID: 27773578 DOI: 10.1016/j.jtcvs.2016.09.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The symmetry of mitral valve tethering and regional left ventricle wall dysfunction are reported to play a fundamental role in the outcomes and long-term durability of surgical repair in ischemic mitral regurgitation (IMR). We recently demonstrated in a randomized clinical trial (the Papillary Muscle Approximation trial) the superiority of papillary muscle approximation (PMA) in combination with standard restrictive annuloplasty (RA) in severe IMR over annuloplasty alone in terms of adverse left ventricular remodeling and mitral regurgitation (MR) recurrence. This approach, however, failed to produce a survival advantage and was still plagued by a high incidence of reoperation. We therefore performed a subanalysis of the PMA trial on the basis of preoperative parameters to elucidate the value of subvalvular surgery in certain subcategories of patients with the aim of creating a decisional algorithm on the best operative strategy. METHODS We performed a subanalysis of PMA trial, evaluating 96 patients with severe IMR and eligible for myocardial revascularization randomized to PMA + RA (n = 48) versus RA alone (n = 48) in association with coronary artery bypass grafting. Endpoints included left ventricular remodeling, MR recurrence, overall mortality, reoperation, and a composite cardiac endpoint (cardiac death, stroke, reintervention, hospitalization for heart failure, or New York Heart Association class worsening). Stratification variables were preoperative symmetry of mitral valve tethering and regional wall motion abnormality. RESULTS PMA improved ventricular remodeling and recurrence of MR in both preoperative symmetric and asymmetric tethering and in case of inferior wall dyskinesia but did not produce an additional benefit in anterolateral wall dysfunction. CONCLUSIONS Preoperative symmetric and asymmetric tethering and isolated inferior wall dyskinesia are an indication for subvalvular apparatus surgery in IMR.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
| | - Cristiano Spadaccio
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimiliano Fraldi
- Department of Structures for Engineering and Architecture and Interdisciplinary Research Center for Biomaterials, Università di Napoli "Federico II," Naples, Italy
| | - Christophe Acar
- Department of Cardiac Surgery, Hopital La Pitie Salpetriere, Paris, France
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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23
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Khalique OK, Hahn RT. Multimodality Imaging in Transcatheter Mitral Interventions. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005071. [DOI: 10.1161/circimaging.116.005071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Omar K. Khalique
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
| | - Rebecca T. Hahn
- From the Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY
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24
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Revuelta JM, León JM. Insuficiencia mitral isquémica crónica: fuente de confusión. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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25
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Machino-Ohtsuka T, Seo Y, Ishizu T, Sato K, Sugano A, Yamamoto M, Hamada-Harimura Y, Aonuma K. Novel Mechanistic Insights Into Atrial Functional Mitral Regurgitation – 3-Dimensional Echocardiographic Study –. Circ J 2016; 80:2240-8. [DOI: 10.1253/circj.cj-16-0435] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Kimi Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Akinori Sugano
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | | | | | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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26
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Levine RA, Hagége AA, Judge DP, Padala M, Dal-Bianco JP, Aikawa E, Beaudoin J, Bischoff J, Bouatia-Naji N, Bruneval P, Butcher JT, Carpentier A, Chaput M, Chester AH, Clusel C, Delling FN, Dietz HC, Dina C, Durst R, Fernandez-Friera L, Handschumacher MD, Jensen MO, Jeunemaitre XP, Le Marec H, Le Tourneau T, Markwald RR, Mérot J, Messas E, Milan DP, Neri T, Norris RA, Peal D, Perrocheau M, Probst V, Pucéat M, Rosenthal N, Solis J, Schott JJ, Schwammenthal E, Slaugenhaupt SA, Song JK, Yacoub MH. Mitral valve disease--morphology and mechanisms. Nat Rev Cardiol 2015; 12:689-710. [PMID: 26483167 DOI: 10.1038/nrcardio.2015.161] [Citation(s) in RCA: 231] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mitral valve disease is a frequent cause of heart failure and death. Emerging evidence indicates that the mitral valve is not a passive structure, but--even in adult life--remains dynamic and accessible for treatment. This concept motivates efforts to reduce the clinical progression of mitral valve disease through early detection and modification of underlying mechanisms. Discoveries of genetic mutations causing mitral valve elongation and prolapse have revealed that growth factor signalling and cell migration pathways are regulated by structural molecules in ways that can be modified to limit progression from developmental defects to valve degeneration with clinical complications. Mitral valve enlargement can determine left ventricular outflow tract obstruction in hypertrophic cardiomyopathy, and might be stimulated by potentially modifiable biological valvular-ventricular interactions. Mitral valve plasticity also allows adaptive growth in response to ventricular remodelling. However, adverse cellular and mechanobiological processes create relative leaflet deficiency in the ischaemic setting, leading to mitral regurgitation with increased heart failure and mortality. Our approach, which bridges clinicians and basic scientists, enables the correlation of observed disease with cellular and molecular mechanisms, leading to the discovery of new opportunities for improving the natural history of mitral valve disease.
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Affiliation(s)
- Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5E, Boston, MA 02114, USA
| | - Albert A Hagége
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | | | | | - Jacob P Dal-Bianco
- Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Harvard Medical School, Boston, MA, USA
| | | | | | | | - Nabila Bouatia-Naji
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | - Patrick Bruneval
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | | | - Alain Carpentier
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | | | | | | | - Francesca N Delling
- Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA
| | | | - Christian Dina
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | - Ronen Durst
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Leticia Fernandez-Friera
- Hospital Universitario HM Monteprincipe and the Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain
| | - Mark D Handschumacher
- Massachusetts General Hospital, Cardiac Ultrasound Laboratory, Harvard Medical School, Boston, MA, USA
| | | | - Xavier P Jeunemaitre
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | - Hervé Le Marec
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | - Thierry Le Tourneau
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | | | - Jean Mérot
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | - Emmanuel Messas
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | - David P Milan
- Cardiovascular Research Center, Harvard Medical School, Boston, MA, USA
| | - Tui Neri
- Aix-Marseille University, INSERM UMR 910, Marseille, France
| | | | - David Peal
- Cardiovascular Research Center, Harvard Medical School, Boston, MA, USA
| | - Maelle Perrocheau
- Hôpital Européen Georges Pompidou, Université René Descartes, UMR 970, Paris, France
| | - Vincent Probst
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | - Michael Pucéat
- Aix-Marseille University, INSERM UMR 910, Marseille, France
| | | | - Jorge Solis
- Hospital Universitario HM Monteprincipe and the Centro Nacional de Investigaciones Cardiovasculares, Carlos III (CNIC), Madrid, Spain
| | - Jean-Jacques Schott
- University of Nantes, Thoracic Institute, INSERM UMR 1097, CNRS UMR 6291, Nantes, France
| | | | - Susan A Slaugenhaupt
- Center for Human Genetic Research, MGH Research Institute, Harvard Medical School, Boston, MA, USA
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27
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Abstract
Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.
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Affiliation(s)
- Rebecca Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
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28
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Abstract
PURPOSE OF REVIEW This review provides an outline of recent applications related to the use of ultrasonography in various catheter-based procedures for the repair of many valvular abnormalities. RECENT FINDINGS Percutaneous interventions are becoming a safe and effective therapeutic modality in the management of various valvular defects. The intrinsic ability of ultrasound to provide real-time accurate assessment of cardiac and valvular structural and functional abnormalities makes this modality distinctively useful in the execution of percutaneous valvular procedures and evaluation of their results.Clinical applications of myocardial deformation and cardiac mechanics have been investigated in an increasing number of clinical applications. Speckle tracking accurately measures myocardial deformation parameters and has been recently applied to the evaluation of mitral insufficiency mechanisms. SUMMARY Recent developments in echocardiography are promoting this modality from its traditional role of diagnostic technique into one suitable for aiding in the execution of complex catheter-based procedures and for accurate monitoring of therapeutic response in many clinical settings.
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29
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Nikolaos K, Ioanna K, Ioanna X, George H, Dimitrios A. Lack of mitral valve leaflet coaptation in a case of non-compaction cardiomyopathy. Int J Cardiol 2015; 187:272. [DOI: 10.1016/j.ijcard.2015.03.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 10/23/2022]
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30
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Dudzinski DM, Hung J. Echocardiographic assessment of ischemic mitral regurgitation. Cardiovasc Ultrasound 2014; 12:46. [PMID: 25416497 PMCID: PMC4277822 DOI: 10.1186/1476-7120-12-46] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Ischemic mitral regurgitation is an important consequence of LV remodeling after myocardial infarction. Echocardiographic diagnosis and assessment of ischemic mitral regurgitation are critical to gauge its adverse effects on prognosis and to attempt to tailor rational treatment strategy. There is no single approach to the echocardiographic assessment of ischemic mitral regurgitation: standard echocardiographic measures of mitral regurgitation severity and of LV dysfunction are complemented by assessments of displacement of the papillary muscles and quantitative indices of mitral valve deformation. Development of novel approaches to understand mitral valve geometry by echocardiography may improve understanding of the mechanism, clinical trajectory, and reparability of ischemic mitral regurgitation.
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Affiliation(s)
| | - Judy Hung
- Echocardiography Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA.
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31
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Lee APW, Fang F, Jin CN, Kam KKH, Tsui GK, Wong KK, Looi JL, Wong RH, Wan S, Sun JP, Underwood MJ, Yu CM. Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography. Circ J 2014; 78:1029-37. [DOI: 10.1253/circj.cj-14-0373] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alex Pui-Wai Lee
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Fang Fang
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Chun-Na Jin
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Kevin Ka-Ho Kam
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Gary K.W. Tsui
- Department of Computer Science, The University of Hong Kong
| | | | - Jen-Li Looi
- Department of Cardiology, Middlemore Hospital
| | - Randolph H.L. Wong
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Song Wan
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Jing Ping Sun
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Malcolm J. Underwood
- Division of Cardiothoracic Surgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Cheuk-Man Yu
- Division of Cardiology, Li Ka Shing Institute of Health Sciences, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong
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