In Patients with Post-Infarction Left Ventricular Dysfunction, How Does Impaired Basal Rotation Affect Chronic Ischemic Mitral Regurgitation?

Zito, Concetta; Cusmà-Piccione, Maurizio; Oreto, Lilia; Tripepi, Sonia; Mohammed, M.; Bella, Gianluca Di; Falanga, Gabriella; Oreto, Giuseppe; Lentini, Salvatore; Carerj, Scipione

doi:10.1016/j.echo.2013.04.017

Cited by 19 publications

(12 citation statements)

References 40 publications

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“…12,13 Regional remodeling after inferior or posterior MI has also been linked to chronic MR, due to impaired LV basal rotational mechanics. 14 Taken together, these prior studies suggest that our observed association between MR and rest inferior/inferolateral perfusion defects is due to the impact of localized LV remodeling on mitral apparatus geometry or function.…”

Section: Discussionsupporting

confidence: 59%

Effect of Myocardial Perfusion Pattern on Frequency and Severity of Mitral Regurgitation in Patients With Known or Suspected Coronary Artery Disease

Volo¹,

Kim²,

Gurevich³

et al. 2014

The American Journal of Cardiology

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Mitral regurgitation (MR) is common with coronary artery disease (CAD), as altered myocardial substrate can impact valve performance. SPECT myocardial perfusion imaging (MPI) enables assessment of myocardial perfusion alterations. This study examined perfusion pattern in relation to MR. 2377 consecutive patients with known or suspected CAD underwent stress MPI and echocardiography (echo) within 1.6±2.3 days. MR was present on echo in 34% of patients, among whom 13% had advanced (≥moderate) MR. MR prevalence was higher among patients with abnormal MPI (44% vs. 29%, p<0.001), corresponding to increased global ischemia (p<0.001). Regional perfusion varied in left ventricular (LV) segments adjacent to each papillary muscle: Adjacent to the anterolateral papillary muscle, magnitude of baseline and stress-induced anterior/anterolateral perfusion abnormalities was greater among patients with MR (both p<0.001). Adjacent to the posteromedial papillary muscle, baseline inferior/inferolateral perfusion abnormalities were greater with MR (p<0.001), whereas stress inducibility was similar (p=0.39). In multivariate analysis, stress-induced anterior/anterolateral and rest inferior/inferolateral perfusion abnormalities were independently associated with MR (both p<0.05) even after controlling for perfusion in reference segments not adjacent to the papillary muscles. MR severity increased in relation to magnitude of perfusion abnormalities in each territory adjacent to the papillary muscles, as evidenced by greater prevalence of advanced MR among patients with ≥moderate anterior/anterolateral stress perfusion abnormalities (10.7% vs. 3.6%), with similar results when MR was stratified based on rest inferior/inferolateral perfusion (10.4% vs. 3.0%, both p<0.001). In conclusion, findings demonstrate that myocardial perfusion pattern in LV segments adjacent to the papillary muscles influences presence and severity of MR.

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Section: Discussionsupporting

confidence: 59%

Effect of Myocardial Perfusion Pattern on Frequency and Severity of Mitral Regurgitation in Patients With Known or Suspected Coronary Artery Disease

Volo¹,

Kim²,

Gurevich³

et al. 2014

The American Journal of Cardiology

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“…For example, global LV dilatation with radially outward and apical displacement of both PMs causes symmetric tenting of both leaflets. Inferoposterior infarction [ 10 ] with local adverse remodelling predominantly affects the posteromedial PM and restricts the posterior leaflet motion, causing a relative overriding of the coaptation zone by the non-tethered leaflet (“pseudoprolapse”). The coaptation zone, although more apically displaced in symmetric tethering, is less geometrically deformed than in asymmetric tethering.…”

Section: Introductionmentioning

confidence: 99%

Echocardiographic assessment of ischemic mitral regurgitation

Dudzinski

Hung

2014

Cardiovasc Ultrasound

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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.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-7120-12-46) contains supplementary material, which is available to authorized users.

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“…[15][16][17][18] In this respect, the application of new technologies in improving the accuracy of stress echocardiography to diagnose CAD, by overcoming the limitation of subjective myocardial WM assessment depending on operator experience and technical skills, in recent years appeared particularly promising. This applies primarily to DipSE, which is affected by lower diagnostic accuracy in single-vessel CAD than other stressors, including dobutamine and exercise, which are currently preferentially used as first-line methods to trigger myocardial ischemia.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography

Cusmà-Piccione

Zito

Oreto

et al. 2015

Journal of the American Society of Echocardiography

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In Patients with Post-Infarction Left Ventricular Dysfunction, How Does Impaired Basal Rotation Affect Chronic Ischemic Mitral Regurgitation?

Cited by 19 publications

References 40 publications

Effect of Myocardial Perfusion Pattern on Frequency and Severity of Mitral Regurgitation in Patients With Known or Suspected Coronary Artery Disease

Effect of Myocardial Perfusion Pattern on Frequency and Severity of Mitral Regurgitation in Patients With Known or Suspected Coronary Artery Disease

Echocardiographic assessment of ischemic mitral regurgitation

Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography

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