Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the surgical treatment for ischemic heart failure trial)

Krzysztof Golba, Krzysztof Mokrzycki, Jaroslaw Drozdz, Alexander Cherniavsky, Krzysztof Wrobel, Bradley J. Roberts, Haissam Haddad, Gerald Maurer, Michael Yii, Federico M. Asch, Mark D. Handschumacher, Thomas A. Holly, Roman Przybylski, Irving Kron, Hartzell V Schaff, Susan Aston, John Horton, Kerry L. Lee, Eric J. Velazquez, Paul A. Grayburn

Research output: Contribution to journalArticle

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Abstract

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 heterogenous, but no single variable stands out as a strong predictor of quantitative severity of MR.

Original languageEnglish (US)
Pages (from-to)1812-1818
Number of pages7
JournalAmerican Journal of Cardiology
Volume112
Issue number11
DOIs
StatePublished - Dec 1 2013

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Transesophageal Echocardiography
Mitral Valve Insufficiency
Cardiomyopathies
Heart Failure
Stroke Volume
Therapeutics
Multivariate Analysis
Randomized Controlled Trials

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the surgical treatment for ischemic heart failure trial). / Golba, Krzysztof; Mokrzycki, Krzysztof; Drozdz, Jaroslaw; Cherniavsky, Alexander; Wrobel, Krzysztof; Roberts, Bradley J.; Haddad, Haissam; Maurer, Gerald; Yii, Michael; Asch, Federico M.; Handschumacher, Mark D.; Holly, Thomas A.; Przybylski, Roman; Kron, Irving; Schaff, Hartzell V; Aston, Susan; Horton, John; Lee, Kerry L.; Velazquez, Eric J.; Grayburn, Paul A.

In: American Journal of Cardiology, Vol. 112, No. 11, 01.12.2013, p. 1812-1818.

Research output: Contribution to journalArticle

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, HV, Aston, S, Horton, J, Lee, KL, Velazquez, EJ & Grayburn, PA 2013, 'Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the surgical treatment for ischemic heart failure trial)', American Journal of Cardiology, vol. 112, no. 11, pp. 1812-1818. https://doi.org/10.1016/j.amjcard.2013.07.047
Golba, Krzysztof ; Mokrzycki, Krzysztof ; Drozdz, Jaroslaw ; Cherniavsky, Alexander ; Wrobel, Krzysztof ; Roberts, Bradley J. ; Haddad, Haissam ; Maurer, Gerald ; Yii, Michael ; Asch, Federico M. ; Handschumacher, Mark D. ; Holly, Thomas A. ; Przybylski, Roman ; Kron, Irving ; Schaff, Hartzell V ; Aston, Susan ; Horton, John ; Lee, Kerry L. ; Velazquez, Eric J. ; Grayburn, Paul A. / Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the surgical treatment for ischemic heart failure trial). In: American Journal of Cardiology. 2013 ; Vol. 112, No. 11. pp. 1812-1818.
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abstract = "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 heterogenous, but no single variable stands out as a strong predictor of quantitative severity of MR.",
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AU - Golba, Krzysztof

AU - Mokrzycki, Krzysztof

AU - Drozdz, Jaroslaw

AU - Cherniavsky, Alexander

AU - Wrobel, Krzysztof

AU - Roberts, Bradley J.

AU - Haddad, Haissam

AU - Maurer, Gerald

AU - Yii, Michael

AU - Asch, Federico M.

AU - Handschumacher, Mark D.

AU - Holly, Thomas A.

AU - Przybylski, Roman

AU - Kron, Irving

AU - Schaff, Hartzell V

AU - Aston, Susan

AU - Horton, John

AU - Lee, Kerry L.

AU - Velazquez, Eric J.

AU - Grayburn, Paul A.

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N2 - 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 heterogenous, but no single variable stands out as a strong predictor of quantitative severity of MR.

AB - 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 heterogenous, but no single variable stands out as a strong predictor of quantitative severity of MR.

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