Shun Nishino1, Nozomi Watanabe2, Toshiyuki Kimura1, Nehiro Kuriyama1, Yoshisato Shibata1. 1. Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Japan. 2. Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Japan. n_watanabe@cure.or.jp.
Abstract
BACKGROUND: Little is known on the mechanism of acute ischemic mitral regurgitation (IMR) caused by sudden-onset left ventricular dysfunction in acute myocardial infarction (MI). We sought to investigate the mitral valve (MV) complex geometry in acute IMR in comparison with chronic IMR by 2-dimensional and 3-dimensional transthoracic echocardiography. METHODS AND RESULTS: Forty-four first-onset acute MI and 36 previous MI with ≥moderate IMR were examined by 2-dimensional/3-dimensional transthoracic echocardiography. MV morphology was quantitatively analyzed and compared between the 2 groups. Left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly smaller in acute IMR than in chronic IMR (40.8 [33.1-48.3] versus 88.8 [66.5-108.8] mL/m2; P<0.001, 17.8 [17.0-30.1] versus 49.5 [34.2-73.7] mL/m2; P<0.001). MV tenting volume and annular area were significantly smaller in acute IMR compared with chronic IMR (0.98 [0.66-1.68] versus 1.88 [1.16-2.65] cm3/m2; P=0.008, 5.17 [4.80-5.86] versus 5.81 [5.47-8.22] cm2/m2; P=0.008). Leaflet surface area was significantly smaller in acute IMR than in chronic IMR (5.78 [5.16-6.32] versus 7.56 [6.89-11.32] cm2/m2; P<0.001). The ratio of MV leaflet surface area and MV annular area was significantly smaller in acute IMR than in chronic IMR (1.08 [1.01-1.14] versus 1.28 [1.24-1.37]; P=0.001). CONCLUSIONS: Sudden-onset left ventricular dysfunction in acute MI may cause loss of coaptation of the MV even with a relatively mild degree of valve tethering. Compared with previously studied chronic IMR, a smaller leaflet area without leaflet adaptation and a larger hemodynamic burden at the acute onset of MI could result in clinically significant IMR despite relatively small leaflet tethering.
BACKGROUND: Little is known on the mechanism of acute ischemic mitral regurgitation (IMR) caused by sudden-onset left ventricular dysfunction in acute myocardial infarction (MI). We sought to investigate the mitral valve (MV) complex geometry in acute IMR in comparison with chronic IMR by 2-dimensional and 3-dimensional transthoracic echocardiography. METHODS AND RESULTS: Forty-four first-onset acute MI and 36 previous MI with ≥moderate IMR were examined by 2-dimensional/3-dimensional transthoracic echocardiography. MV morphology was quantitatively analyzed and compared between the 2 groups. Left ventricular end-diastolic volume and left ventricular end-systolic volume were significantly smaller in acute IMR than in chronic IMR (40.8 [33.1-48.3] versus 88.8 [66.5-108.8] mL/m2; P<0.001, 17.8 [17.0-30.1] versus 49.5 [34.2-73.7] mL/m2; P<0.001). MV tenting volume and annular area were significantly smaller in acute IMR compared with chronic IMR (0.98 [0.66-1.68] versus 1.88 [1.16-2.65] cm3/m2; P=0.008, 5.17 [4.80-5.86] versus 5.81 [5.47-8.22] cm2/m2; P=0.008). Leaflet surface area was significantly smaller in acute IMR than in chronic IMR (5.78 [5.16-6.32] versus 7.56 [6.89-11.32] cm2/m2; P<0.001). The ratio of MV leaflet surface area and MV annular area was significantly smaller in acute IMR than in chronic IMR (1.08 [1.01-1.14] versus 1.28 [1.24-1.37]; P=0.001). CONCLUSIONS: Sudden-onset left ventricular dysfunction in acute MI may cause loss of coaptation of the MV even with a relatively mild degree of valve tethering. Compared with previously studied chronic IMR, a smaller leaflet area without leaflet adaptation and a larger hemodynamic burden at the acute onset of MI could result in clinically significant IMR despite relatively small leaflet tethering.
Authors: Dae-Hee Kim; Jacob P Dal-Bianco; Elena Aikawa; Joyce Bischoff; Robert A Levine Journal: Circ Cardiovasc Imaging Date: 2018-04 Impact factor: 7.792
Authors: Maria von Stumm; Florian Dudde; Theresa Holst; Tatjana Sequeira-Gross; Jonas Pausch; Lisa Müller; Christoph R Sinning; Hermann Reichenspurner; E Girdauskas Journal: Open Heart Date: 2021-01