Abstract
Methods 56 patients (58 ± 17 years, 42 men) with DCM and FMR and 52 controls, prospectively enrolled, underwent 3DTTE dedicated for mitral valve (MV), LA, and left ventricle (LV) quantitative analysis. Results Patients with FMR vs. controls presented increased MA size and sphericity during the entire systole, whereas MA fractional area change (MAFAC) and MA displacement were decreased (15 ± 5 vs. 28 ± 5%; and 5 ± 3 vs. 10 ± 2 mm, p < 0.001). In patients with moderate/severe FMR, MA diameters correlated with PISA radius, EROA, and regurgitant volume (Rvol), as also did the MA area (with PISA radius, EROA, and Rvol: r = 0.48, r = 0.58, and r = 0.47, p < 0.05). MAFAC correlated inversely with EROA and Rvol (r = −0.32 and r = −0.35, p < 0.05), with both active and total LA emptying fractions and with LV ejection fraction as well. In a stepwise multivariate regression model, decreased MAFAC and increased LA volume independently predicted patients with severe FMR. Conclusions Patients with DCM and FMR have MA geometry remodeling and contractile dysfunction, correlated with the severity of FMR. MA contractile dysfunction correlated with both LA and left LV pumps dysfunctions and predicted patients with severe FMR. Our results provide new insights that might help with better selection of patients for MV transcatheter procedures.
Highlights
Introduction and ObjectivesPatients with dilated cardiomyopathy (DCM) and functional mitral regurgitation (FMR) present altered geometry and dynamics of the mitral annulus (MA)
The MA is a complex tridimensional structure, which cannot be characterized by a single annular diameter [8, 9]. erefore, understanding the geometrical and functional changes occurring in the MA, as well as their relations with the LA and left ventricle (LV) dilation and function, is essential in patients with DCM and FMR [10]. is is possible with the progress of three-dimensional (3D) full-volume acquisition with high temporal and spatial resolution using transthoracic echocardiography (3DTTE), coupled with the development of specific software packages, which enable a detailed quantitative analysis of MA [11], LV, and LA geometry and functions
Patients with DCM had an ischemic etiology in 40 cases (71%); they were in NYHA functional class I in 5 cases (9%), II in 26 cases (46%), and III in 25 cases (45%). 17 patients (30%) had mild, 25 (45%) moderate, and 14 (25%) severe FMR
Summary
Patients with dilated cardiomyopathy (DCM) and functional mitral regurgitation (FMR) present altered geometry and dynamics of the mitral annulus (MA). We aimed to further assess the relationship between the MA dysfunction, FMR severity, and LA dysfunction in patients with ischemic and nonischemic DCM by using three-dimensional transthoracic echocardiography (3DTTE). Functional mitral regurgitation (FMR) is a common complication in patients with ischemic or nonischemic dilated cardiomyopathy (DCM), increasing mortality, and the risk of rehospitalization [1]. We designed our study (i) to characterize MA geometry and dynamics changes, as the remodeling of the MA, by using 3DTTE in patients with DCM and FMR, in comparison with healthy controls; (ii) to assess the relationship between MA remodeling and severity of FMR; and (iii) to assess the relationship between MA dysfunction and severity of LV and LA dilation and dysfunction The MA is a complex tridimensional structure, which cannot be characterized by a single annular diameter [8, 9]. erefore, understanding the geometrical and functional changes occurring in the MA, as well as their relations with the LA and LV dilation and function, is essential in patients with DCM and FMR [10]. is is possible with the progress of three-dimensional (3D) full-volume acquisition with high temporal and spatial resolution using transthoracic echocardiography (3DTTE), coupled with the development of specific software packages, which enable a detailed quantitative analysis of MA [11], LV, and LA geometry and functions.
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