Abstract
Functional mitral regurgitation (FMR) is frequent in left ventricular (LV) dilatation/dysfunction. Echocardiographic predictors of FMR are known. However, cardiac magnetic resonance (CMR) predictors of FMR have not been fully addressed. The aim of the study was to evaluate CMR mitral valve (MV) parameters associated with FMR in ischemic and non ischemic LV dysfunction. 80 patients with LV ejection fraction bellow 45% and/or left ventricular dilatation of ischemic and non ischemic etiology were included. Cine-MR images (steady state free-precession) were acquired in a short-axis and 4 chambers views where MV evaluation was performed. Delayed enhancement was performed as well. Significant FMR was established as more than mild MR according to the echocardiographic report. Mean age was 59 years, males 79%. FMR was detected in 20 patients (25%) Significant differences were noted in LV functional parameters and in most MV parameters according to the presence of significant FMR. However, differences were noted between ischemic and non ischemic groups. In the first, differences in most MV parameters remained significant while in the non ischemic, only systolic and diastolic interpapillary muscle distance (1.60 vs. 2.19 cm, P = 0.001; 2. 51 vs. 3.04, P = 0.008) were predictors of FMR. FMR is associated with a more severe LV dilatation/dysfunction in the overall population. CMR MV parameters are associated with the presence of significant FMR and are different between ischemic and non ischemic patients. CMR evaluation of these patients may help in risk stratification as well as in surgical candidate selection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rankin JS, Hickey MSJ, Smith LR et al (1989) Ischemic mitral regurgitation. Circulation 79:I-116–I-121
Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik J (2001) Ischemic mitral regurgitation long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103:1759–1764
Grigioni F, Detaint D, Avierinos JF, Scott C, Tajik J, Enriquez-Sarano M (2005) Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction. J Am Coll Cardiol 45:260–267
Pérez de Isla L, Zamorano J, Quezada M et al (2007) Functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome: contribution to congestive heart failure. Eur Heart J 28:2866–2872
Pérez de Isla L, Zamorano J, Quezada M et al (2006) Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome. Eur Heart J 27:2655–2660
Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ (2000) Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction a quantitative clinical study. Circulation 102:1400–1406
Sadeghpour A, Abtahi F, Kiavar M (2008) Echocardiographic evaluation of mitral geometry in functional mitral regurgitation. J Cardiothorac Surg 3:54–60
Lee AP, Acker M, Kubo SH et al (2009) Mechanisms of recurrent functional mitral regurgitation after mitral valve repair in nonischemic dilated cardiomyopathy importance of distal anterior leaflet tethering. Circulation 119:2606–2614
Di Giammarco G, Liberi R, Giancane M et al (2007) Recurrence of functional mitral regurgitation in patients with dilated cardiomyopathy undergoing mitral valve repair: how to predict it. Interact Cardiovasc Thorac Surg 6:340–344
Kongsaerepong V, Shiota M, Gillinov AM et al (2006) Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation. Am J Cardiol 98:504–508
Nagasaki M, Nishimura S, Ohtaki E (2006) The echocardiographic determinants of functional mitral regurgitation differ in ischemic and non-ischemic cardiomyopathy. Int J of Card 108:171–176
D’Ancona G, Mamone G, Marrone G et al (2007) Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging. Eur J of Cardio-Thoracic Surg 32:475–480
Kaji S, Nasu M, Yamamuro A et al (2005) Annular geometry in patients with chronic ischemic mitral regurgitation three-dimensional magnetic resonance imaging study. Circulation 112:I-409–I-414
Yu HY, Su MY, Liao TY, Peng HH, Lin FY, Tseng WI (2004) Functional mitral regurgitation in chronic ischemic coronary artery disease: Analysis of geometric alterations of mitral apparatus with magnetic resonance imaging. J Thorac Cardiovasc Surg 128:543–551
Srichai MB, Grimm RA, Stillman AE et al (2005) Ischemic mitral regurgitation: impact of the left ventricle and Mitral valve in patients with left ventricular systolic dysfunction. Ann Thorac Surg 80:170–178
Gabriell RS, Kerr AJ, Raffell OC, Stewart RA, Cowan BR, Occleshaw CJ (2008) Mapping of mitral regurgitant defects by cardiovascular magnetic resonance in moderate or severe mitral regurgitation secondary to mitral valve prolapse. J Cardiovasc Magn Reson 9:16
D’Ancona G, Biondo D, Mamone G et al (2008) Ischemic mitral valve regurgitation in patients with depressed ventricular function: cardiac geometrical and myocardial perfusion evaluation with magnetic resonance imaging. Eur J Cardiothorac Surg 34:964–968
Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fernández-Golfín, C., De Agustin, A., Manzano, M.C. et al. Cardiac magnetic resonance determinants of functional mitral regurgitation in ischemic and non ischemic left ventricular dysfunction. Int J Cardiovasc Imaging 27, 539–546 (2011). https://doi.org/10.1007/s10554-010-9696-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10554-010-9696-y