Functional mitral regurgitation in patients with aortic stenosis: Prevalence, clinical correlates and pathophysiological determinants: A quantitative prospective study

Andrea Rossi, Rajesh Dandale, Stefano Nistri, Pompilio Faggiano, Mariantonietta Cicoira, Giovanni Benfari, Francesco Onorati, Francesco Santini, David Messika-Zeitoun, Maurice E Sarano, Corrado Vassanelli

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Abstract

AimsIn patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.Methods and resultsWe prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50 female, EF 57 ± 14, AVA 1.00 ± 0.4 cm2). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm2). ERO was significantly associated with LVD (rho 0.34; P 0.0001), EF (rs-0.35: P 0.0001), and S-DTI (r-0.57; P 0.0001), A-DTI (rho-0.47; P 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m2 and EF >55), S-DTI, and A-DTI were the variables with the more powerful association with ERO (rs-0.49 P 0.0001 and rs-0.40 P 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: rs-0.08 P 0.2 and AVA: rs-0.08 P 0.2).ConclusionIn AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.

Original languageEnglish (US)
Pages (from-to)631-636
Number of pages6
JournalEuropean Heart Journal Cardiovascular Imaging
Volume15
Issue number6
DOIs
StatePublished - 2014

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Aortic Valve Stenosis
Mitral Valve Insufficiency
Prospective Studies
Aortic Valve
Ventricular Remodeling
Left Ventricular Function
Population

Keywords

  • aortic stenosis
  • echocardiography
  • functional mitral regurgitation
  • left ventricular function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Functional mitral regurgitation in patients with aortic stenosis : Prevalence, clinical correlates and pathophysiological determinants: A quantitative prospective study. / Rossi, Andrea; Dandale, Rajesh; Nistri, Stefano; Faggiano, Pompilio; Cicoira, Mariantonietta; Benfari, Giovanni; Onorati, Francesco; Santini, Francesco; Messika-Zeitoun, David; Sarano, Maurice E; Vassanelli, Corrado.

In: European Heart Journal Cardiovascular Imaging, Vol. 15, No. 6, 2014, p. 631-636.

Research output: Contribution to journalArticle

Rossi, Andrea ; Dandale, Rajesh ; Nistri, Stefano ; Faggiano, Pompilio ; Cicoira, Mariantonietta ; Benfari, Giovanni ; Onorati, Francesco ; Santini, Francesco ; Messika-Zeitoun, David ; Sarano, Maurice E ; Vassanelli, Corrado. / Functional mitral regurgitation in patients with aortic stenosis : Prevalence, clinical correlates and pathophysiological determinants: A quantitative prospective study. In: European Heart Journal Cardiovascular Imaging. 2014 ; Vol. 15, No. 6. pp. 631-636.
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abstract = "AimsIn patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.Methods and resultsWe prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50 female, EF 57 ± 14, AVA 1.00 ± 0.4 cm2). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm2). ERO was significantly associated with LVD (rho 0.34; P 0.0001), EF (rs-0.35: P 0.0001), and S-DTI (r-0.57; P 0.0001), A-DTI (rho-0.47; P 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m2 and EF >55), S-DTI, and A-DTI were the variables with the more powerful association with ERO (rs-0.49 P 0.0001 and rs-0.40 P 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: rs-0.08 P 0.2 and AVA: rs-0.08 P 0.2).ConclusionIn AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.",
keywords = "aortic stenosis, echocardiography, functional mitral regurgitation, left ventricular function",
author = "Andrea Rossi and Rajesh Dandale and Stefano Nistri and Pompilio Faggiano and Mariantonietta Cicoira and Giovanni Benfari and Francesco Onorati and Francesco Santini and David Messika-Zeitoun and Sarano, {Maurice E} and Corrado Vassanelli",
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TY - JOUR

T1 - Functional mitral regurgitation in patients with aortic stenosis

T2 - Prevalence, clinical correlates and pathophysiological determinants: A quantitative prospective study

AU - Rossi, Andrea

AU - Dandale, Rajesh

AU - Nistri, Stefano

AU - Faggiano, Pompilio

AU - Cicoira, Mariantonietta

AU - Benfari, Giovanni

AU - Onorati, Francesco

AU - Santini, Francesco

AU - Messika-Zeitoun, David

AU - Sarano, Maurice E

AU - Vassanelli, Corrado

PY - 2014

Y1 - 2014

N2 - AimsIn patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.Methods and resultsWe prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50 female, EF 57 ± 14, AVA 1.00 ± 0.4 cm2). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm2). ERO was significantly associated with LVD (rho 0.34; P 0.0001), EF (rs-0.35: P 0.0001), and S-DTI (r-0.57; P 0.0001), A-DTI (rho-0.47; P 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m2 and EF >55), S-DTI, and A-DTI were the variables with the more powerful association with ERO (rs-0.49 P 0.0001 and rs-0.40 P 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: rs-0.08 P 0.2 and AVA: rs-0.08 P 0.2).ConclusionIn AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.

AB - AimsIn patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.Methods and resultsWe prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50 female, EF 57 ± 14, AVA 1.00 ± 0.4 cm2). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm2). ERO was significantly associated with LVD (rho 0.34; P 0.0001), EF (rs-0.35: P 0.0001), and S-DTI (r-0.57; P 0.0001), A-DTI (rho-0.47; P 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m2 and EF >55), S-DTI, and A-DTI were the variables with the more powerful association with ERO (rs-0.49 P 0.0001 and rs-0.40 P 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: rs-0.08 P 0.2 and AVA: rs-0.08 P 0.2).ConclusionIn AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.

KW - aortic stenosis

KW - echocardiography

KW - functional mitral regurgitation

KW - left ventricular function

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