Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: A quantitative clinical study

Siu F. Yiu, Maurice E Sarano, Christophe Tribouilloy, James B. Seward, A. Jamil Tajik

Research output: Contribution to journalArticle

532 Citations (Scopus)

Abstract

Background - Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered. Methods and Results - In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50%, mean 31±9%) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15±14 mm2, 0 to 87 mm2) was observed, unrelated to ejection fraction (P=0.32). The major determinant of ERa was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P<0.0001) and multivariate (both P<0.0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P<0.0001), independent of LV volumes, function, and sphericity. Conclusions - The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.

Original languageEnglish (US)
Pages (from-to)1400-1406
Number of pages7
JournalCirculation
Volume102
Issue number12
StatePublished - Sep 19 2000

Fingerprint

Mitral Valve Insufficiency
Left Ventricular Dysfunction
Ventricular Remodeling
Papillary Muscles
Clinical Studies
Mitral Valve
Left Ventricular Function
Echocardiography
Multivariate Analysis
Prospective Studies
Therapeutics

Keywords

  • Echocardiography
  • Heart failure
  • Mitral valve
  • Regurgitation
  • Ventricles

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction : A quantitative clinical study. / Yiu, Siu F.; Sarano, Maurice E; Tribouilloy, Christophe; Seward, James B.; Tajik, A. Jamil.

In: Circulation, Vol. 102, No. 12, 19.09.2000, p. 1400-1406.

Research output: Contribution to journalArticle

Yiu, Siu F. ; Sarano, Maurice E ; Tribouilloy, Christophe ; Seward, James B. ; Tajik, A. Jamil. / Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction : A quantitative clinical study. In: Circulation. 2000 ; Vol. 102, No. 12. pp. 1400-1406.
@article{3ee0db8a8b0c4b95a6672eaa24c04df9,
title = "Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: A quantitative clinical study",
abstract = "Background - Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered. Methods and Results - In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50{\%}, mean 31±9{\%}) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15±14 mm2, 0 to 87 mm2) was observed, unrelated to ejection fraction (P=0.32). The major determinant of ERa was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P<0.0001) and multivariate (both P<0.0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P<0.0001), independent of LV volumes, function, and sphericity. Conclusions - The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.",
keywords = "Echocardiography, Heart failure, Mitral valve, Regurgitation, Ventricles",
author = "Yiu, {Siu F.} and Sarano, {Maurice E} and Christophe Tribouilloy and Seward, {James B.} and Tajik, {A. Jamil}",
year = "2000",
month = "9",
day = "19",
language = "English (US)",
volume = "102",
pages = "1400--1406",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction

T2 - A quantitative clinical study

AU - Yiu, Siu F.

AU - Sarano, Maurice E

AU - Tribouilloy, Christophe

AU - Seward, James B.

AU - Tajik, A. Jamil

PY - 2000/9/19

Y1 - 2000/9/19

N2 - Background - Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered. Methods and Results - In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50%, mean 31±9%) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15±14 mm2, 0 to 87 mm2) was observed, unrelated to ejection fraction (P=0.32). The major determinant of ERa was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P<0.0001) and multivariate (both P<0.0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P<0.0001), independent of LV volumes, function, and sphericity. Conclusions - The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.

AB - Background - Functional mitral regurgitation (FMR) occurs with a structurally normal valve as a complication of systolic left ventricular dysfunction (LVD). Determinants of degree of FMR are poorly defined; thus, mechanistic therapeutic approaches to FMR are hindered. Methods and Results - In a prospective study of 21 control subjects and 128 patients with LVD (defined as ejection fraction <50%, mean 31±9%) in sinus rhythm, we quantified simultaneously by echocardiography the effective regurgitant orifice (ERO) of FMR by using 2 methods: mitral deformation (valve and annulus) and left ventricular (LV) global (volumes, stress, function, and sphericity) and local (papillary muscle displacements and regional wall motion index) remodeling. A wide range of ERO (15±14 mm2, 0 to 87 mm2) was observed, unrelated to ejection fraction (P=0.32). The major determinant of ERa was mitral deformation, ie, systolic valvular tenting and annular contraction in univariate (r=0.74 and r=-0.61, respectively; both P<0.0001) and multivariate (both P<0.0001) analyses, independent of global LV remodeling. Systolic valvular tenting was strongly determined by local LV alterations, particularly apical (r=0.75) and posterior (r=0.70) displacement of papillary muscle, with confirmation in multivariate analysis (both P<0.0001), independent of LV volumes, function, and sphericity. Conclusions - The presence and degree of FMR complicating LVD are unrelated to the severity of LVD. Local LV remodeling (apical and posterior displacement of papillary muscles) leads to excess valvular tenting independent of global LV remodeling. In turn, excess tenting and loss of systolic annular contraction are associated with larger EROs. These determinants of FMR warrant consideration for specific approaches to the treatment of FMR complicating LVD.

KW - Echocardiography

KW - Heart failure

KW - Mitral valve

KW - Regurgitation

KW - Ventricles

UR - http://www.scopus.com/inward/record.url?scp=0034687145&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034687145&partnerID=8YFLogxK

M3 - Article

C2 - 10993859

AN - SCOPUS:0034687145

VL - 102

SP - 1400

EP - 1406

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 12

ER -