Predictors of ischemic mitral insufficiency in patients with systolic left ventricular dysfunction after myocardial infarction of different localization
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Abstract
The aim – to estimate the role of geometric parameters of mitral valve deformation and remodeling of the left ventricle (LV) in the formation of mitral insufficiency in patients with systolic dysfunction after myocardial infarction (MI) of different localization.
Material and methods. We assessed 99 patients with left ventricular (LV) systolic dysfiunction after MI with mild to severe mitral insufficiency. We evaluated mitral insufficiency by means of echocardiography through determining EROA (effective regurgitant orifice area), assessed indexes of LV global and local remodeling. mitral insufficiency was
moderate and severe in 36 patients with anterior MI (group 1) and in 43 patients with inferior/posterior MI (group 2), the control group consisted of 21 healthy individuals.
Results. In both groups of patients rates of global and local LV remodeling were significantly higher than in the control group (P<0.0001). Sphericity index was significantly higher in group 1, compared to group 2 (P=0.003). The indexes of local remodeling were significantly higher in group 1, especially anterior papillary muscle (PM) tethering distance (Р=0.03), posterior displacement of the anterior PM (Р=0.03), PM height (Р=0.01), interpapillary distance (Р=0.02). Correlation between EROA and sphericity index in group 1 was revealed (Kendall τ 0.46, P<0.0001), in group 2 this correlation was weak (Kendall τ 0.23, Р=0.016). In group 1 correlation of EROA with anterior and posterior PM tethering distance was revealed (Kendall τ 0.41 and 0.52, P<0.0001). In group 2 EROA correlation with posterior PM tethering distance and anteroposterior mitral valve diameter was revealed (Kendall τ 0.36 and 0.48, P<0,0001). Correlation between EROA and inferior apical segment akinesia and WMSI of posterior PM was revealed in group 1 (Kendall τ 0.71 and 0.51, P<0.0001), and relation between mitral insufficiency and obstructive lesion in circumflexus (Cx) and right coronary artery (RCA) (Р=0.0008 та Р=0.002) in this group.
Conclusions. LV spherisation and PM dislocation are more pronounced in ischemic CMP after anterior MI, compared to inferoposterior MI. Apical and posterior PM displacement, akinesia of inferior apical segment, Cx and RCA obstruction are major determinants of ischemic mitral insufficiency after anterior MI, while posterior PM tethering and anteroposterior mitral annular dilatation are determinants of mitral insufficiency after inferoposterior MI. The obtained data might determine surgical approaches in ischemic mitral insufficiency of different mechanisms.
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Коваленко В.М., Сичов О.С., Іванів Ю.А., Долженко М.М. та ін. Кількісна ехокардіографічна оцінка порожнин серця Рекомендації робочої групи з функціональної діагностики Асоціації кардіологів України та Всеукраїнської громадської організації «Асоціація фахівців з ехокардіографії».– К., 2013.
Agricola E., Oppizzi M., Maisano F. et al. Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern // Eur. J. Echocardiogr.– 2004.– Vol. 5.– P. 326–334.
Agricola E., Ielasi A., Oppizzi M. et al. Long-term prognosis of medically treated patients with functional mitral regurgitation and left ventricular dysfunction // Eur. J. Heart Fail.– 2009.– Vol. 11.– P. 581–587.
Amigoni M., Meris A., Thune J. J. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function // Eur. Heart J.– 2007.– Vol. 28.– P. 326–333.
Bach D.S., Deeb G.M., Bolling S.F. Accuracy of intraoperative transesophageal echocardiography for estimating the severity of functional mitral regurgitation // Am. J. Cardiol.– 1995.– Vol. 76.– P. 508–512.
Benedetto U., Melina G. et al. Does combined mitral valve surgery improve survival when compared to revascularization alone in patients with ischemic mitral regurgitation? A meta-analysis on 2479 patients // J. Cardiovasc. Med.– 2009.– Vol. 10 (2).– P. 109–114.
Bursi F., Enriquez-Sarano M. et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation // Circulation.– 2005.– Vol. 111.– P. 295–301.
Calafiore A.M., Gallina S., Di Mauro M. et al. Mitral valve procedure in dilated cardiomyopathy: repair or replacement? // Ann. Thorac Surg.– 2001.– Vol. 71.– P. 1146–1153.
Calafiore A.M., Di Mauro M., Varone E. Echocardiographically based tratment of chronic ischemic mitral regurgitation // J. Thorac. Cardiovasc. Surg.– 2011.– Vol. 141 (5).– P. 1150–1156.
Chan V., Ruel M., Mesana T. Mitral valve replacement is a viable alternative to mitral valve repair for ischemic mitral regurgitation: a case-matched study // Ann. Thorac. Surg.– 2011.– Vol. 92.– P. 1358–1366.
Deja M.A., Grayburn P.A., Sun B. et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial // Circulation.– 2012.– Vol. 125.– P. 2639–2648.
Deja M.A., Janusiewicz P., Grushchynska K. et al. Mechanisms of functional mitral regurgitation in cardiomyopathy secondary to anterior infarction // Eur. J. Cardiothorac. Surg.– 2014.– Vol. 45 (6).– P. 1089–1096.
Di Donato M., Dabic P., Castelvecchio S. et al. Left ventricular geometry in normal and post-anterior myocardial infarction patients: sphericity index and ‘new’ conicity index comparisons // Eur. J. Cardiothorac. Surg.– 2006.– Vol. 29.– P. S225–S230.
Enriquez-Sarano M., Miller F. J., Hayes S. et al. Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method // J. Am. Coll. Cardiol.– 1995.– Vol. 25.– P. 703–709.
Golba K., Mokrzycki K., Drozdz J. et al. Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial) // Am. J. Cardiol.– 2013.– Vol. 112.– P. 1812–1818.
Goldstein D., Moskowitz A.J., Gelijns A.C. Two-Year Outcomes of Surgical Treatment of Severe Ischemic Mitral Regurgitation // New Engl. J. Med.– 2016.– Vol. 374 (4).– P. 344–353.
Gorman R.C., McCaughan J.S., Ratcliffe M.B. et al. Pathogenesis of acute ischemic mitral regurgitation in three dimensions // J. Thorac. Cardiovasc. Surg.– 1995.– Vol. 109.– P. 684–693.
Gorman J.H., Jackson B.M., Enomoto Y., Gorman R.C. The effect of regional ischemia on mitral valve annular saddle shape // Ann. Thorac. Surg.– 2004.– Vol. 77.– P. 544–548.
Grigioni F., Enriquez-Sarano M., Zehr K.J. et al. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment // Circulation.– 2001.– Vol. 103.– P. 1759–1764.
Grossi E.A., Crooke G.A. Impact of moderate functional mitral insufficiency in patients undergoing surgical revascularization // Circulation – 2006.– Vol. 114 (Suppl. 1).– P. I573–1576.
He S., Fontaine A.A., Schwammenthal E. et al. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coapting force: in vitro studies // Circulation.– 1997.– Vol. 96.– P. 1826–1834.
Hickey M.S., Smith L.R., Muhlbaier L.H. et al. Current prognosis of ischemic mitral regurgitation: Implications for future management // Circulation.– 1988.– Vol. 78.– P. I-51
Hung J., Papakostas L., Tahta S.A. et al. Mechanism of recurrent ischemic mitral regurgitation after annuloplasty: continued LV remodeling as a moving target // Circulation.– 2004.– Vol. 110 (Suppl. II).– P. II-85–II-90.
Kaji S., Nasu M., Yamamuro A. et al. Annular Geometry in Patients With Chronic Ischemic Mitral Regurgitation // Circulation.– 2005.– Vol. 112.– P. I-409–I-414.
Kono T., Sabbah H.N., Rosman H. et al. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure // J. Am. Coll. Cardiol.– 1992.– Vol. 20.– P. 1594–1598.
Kumanohoso T., Otsuji Y., Yoshifuku S. et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients2, with prior myocardial infarction // J. Thorac. Cardiovasc. Surg.– 2003.– Vol. 125.– P. 135–143.
Kwan J., Shiota T., Agler D.A. et al. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study // Circulation.– 2003.– Vol. 107.– P. 1135–1140.
Lamas G.A., Mitchell G.F., Flaker G.C. et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Survival and Ventricular Enlargement Investigators // Circulation.– 1997.– Vol. 96.– P. 827–833.
Lancellotti P., Gérard P.L., Piérard L.A. Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation // Eur. Heart J.– 2005.– Vol. 26.– P. 1528–1532.
Lancellotti P., Moura, L., Pierard L.A. et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease) // Eur. J. Echocardiogr.– 2010.– Vol. 11.– P. 307–332.
Lancellotti P., Tribouilloy C., Hagendorff A. et al. Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging // Eur. Heart J.– Cardiovasc. Imaging.– 2013.– Vol. 14.– P. 611–644.
Lang R.M., Bierig M., Devereux R.B. et al., Members of the Chamber Quantification Writing Group. Recommendations for Chamber Quantification: a Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology // J. Am. Soc. Echocardiogr.– 2005.– Vol. 18.– P. 1440–1463.
Liel-Cohen N., Guerrero J.L., Otsuji Y. et al. Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation: insights from three-dimensional echocardiography // Circulation 2000.– Vol. 101.– P. 2756–2763.
Magne J., Pibarot P., Dumensil J.G., Sénéchal M. Continued global left ventricular remodeling is not the sole mechanism responsible for late recurrence of ischemic mitral regurgitation after restrictive annuloplasty // J. Am. Soc. Echocardiogr.– 2009.– Vol. 22.– P. 1256–1264.
Nishimura R.A., Otto C.M., Bonow R. et al. AHA/ACC Guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on practice guidelines // Circulation.– 2014.– Vol. 129.– P. e521–e643.
Otsuji Y., Handschumacher M., Schwammenthal E. et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry // Circulation.– 1997.– Vol. 96.– P. 1999–2008.
Otsuji Y., Kumanohoso T., Yoshifuku S. et al. Isolated annular dilation does not usually cause important functional mitral regurgitation: comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy // J. Am. Coll. Cardiol.– 2002.– Vol. 39.– P. 1651–1656.
Rossi A., Dini F.L., Faggiano P. et al. Independent prognostic value of functional mitral regurgitation in patients with heart
failure: a quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy // Heart.– Vol. 97.– 2011.– P. 1675–1680.
Szymanski C., Levine R.A., Tribouilloy C. Impact of mitral regurgitation on exercise capacity and clinical outcomes in patients with ischemic left ventricular dysfunction // Am. J. Cardiol.– 2011.– Vol. 108.– P. 1714–1720.
Vahanian A., Baumgartner H., Bax J. et al. Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology // Eur. Heart J.– 2007.– Vol. 28.– P. 230–268.
Watanabe N., Ogasawara Y., Yamaura Y. et al. Geometric differences of the mitral valve tenting between anterior and inferior myocardial infarction with significant ischemic mitral regurgitation: quantitation by novel software system with transthoracic real-time three-dimensional echocardiography // J. Am. Soc. Echocardiogr.– 2006.– Vol. 19.– P. 71–75.
Watanabe N., Ogasawara Y., Yamaura Y. et al. Mitral annulus flattens in ischemic mitral regurgitation: geometric differences between inferior and anterior myocardial infarction: a real-time 3-dimensional echocardiographic study // Circulation.– 2005.– Vol. 112.– P. I458–462.
Yiu S.F., Enriquez-Sarano M., Tribouilloy C. et al. Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study // Circulation.– 2000.– Vol. 102.– P. 1400–1406.
Yosefy C., Beeri R., Guerrero J.L. et al. Mitral regurgitation after anteroapical myocardial infarction: new mechanistic insights // Circulation.– 2011.– Vol. 123.– P. 1529–1536.
Zhang H., Otsuji Y., Uemura, T. et al. Different mechanisms of ischemic mitral regurgitation in patients with inferior and anterior myocardial infarction // J. Echocardiogr.– 2008.– Vol. 3.– P. 74–83.