Role of coaptation imaging of mitral valve on ischemic mitral regurgitation by real-time three-dimensional transesophageal echocardiography

Abstract

Objective To explore the impact of morphological changes of mitral valve coaptation on ischemic mitral regurgitation (IMR), and observe coaptation image of mitral valve in systole in patients with IMR by using real-time three-dimensional transesophageal echocardiography (RT3D-TEE). Methods RT3D-TEE was performed on 112 patients with IMR and 38 patients without MR as the control. Patients with IMR were divided into group of mild IMR (n=46), group of moderate IMR (n=45) and group of severe IMR (n=21), according to the severity of mitral regurgitation. Mitral valve quantification (MVQ) software of Qlab 8.1 was used for image post-processing of RT3D-TEE. The coaptation parameters was measured, included length of anterior combination(LCA3dlf), length of posterior combination(LCP3dlf), area of anterior combination(A3DTANT) and area of posterior combination(A3DTPOST) at end-systole. Then, these coaptation parameters of mitral valve were compared statistically. Logistic regression assessing was applied for analyzing the results. Results Coaptation line of anterior and posterior leaflets was almost same in normal subjects. With increasing of mitral regurgitation, a tendency to prolong in LCA3dlf and LCP3dlf were observed in IMR (P<0.05). Compared to that in mild and moderate IMR groups, besides A3DTANT and A3DTPOST, LCA3dlf and LCP3dlf were also increased significantly in severe IMR group (P<0.05). LCP3dlf was an independent correlation factor of IMR by Logistic regression analysis. The sensitivity was 73.3% and the specificity was 94.7% when LCP3dlf ≥32 mm was regarded as cut-off point, and the area under the ROC curve was 0.949 (0.900~0.999). Conclusions Abnormal coaptation of anterior and posterior leaflets of mitral valve might be one of main cause of IMR. Involution structure of mitral valve before surgery is helpful for surgeon to select an optical surgical procedure and evaluate effects of treatment in patients with IMR. Key words: Echocardiography, real-time three-dimensional; Echocardiography, transesophageal; Mitral valve insufficiency; Myocardial ischemia