Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial).

Journal Article (Journal Article)

The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR.

Full Text

Duke Authors

Cited Authors

  • Golba, K; Mokrzycki, K; Drozdz, J; Cherniavsky, A; Wrobel, K; Roberts, BJ; Haddad, H; Maurer, G; Yii, M; Asch, FM; Handschumacher, MD; Holly, TA; Przybylski, R; Kron, I; Schaff, H; Aston, S; Horton, J; Lee, KL; Velazquez, EJ; Grayburn, PA; STICH TEE Substudy Investigators,

Published Date

  • December 1, 2013

Published In

Volume / Issue

  • 112 / 11

Start / End Page

  • 1812 - 1818

PubMed ID

  • 24035166

Pubmed Central ID

  • PMC3830629

Electronic International Standard Serial Number (EISSN)

  • 1879-1913

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2013.07.047


  • eng

Conference Location

  • United States