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Ischemic mitral regurgitation (IMR) results from mitral leaflet tethering from ischemic LV remodeling. Yet there is heterogeneity in correlating degree of tethering to the IMR severity. In addition to total tethering degree, pattern of tethering (asymmetric vs symmetric) may also influence IMR (Figure). We aimed to examine impact of tethering pattern on IMR severity.
In 62 patients with moderate or greater IMR, symmetric and asymmetric tethering patterns (by imaging and eccentricity of MR jet) were assessed by 3D transesophageal echo (Philips Qlab). The posterior to anterior leaflet tethering angle ratio (P/A) was a measure of tethering pattern (higher the ratio, the more asymmetric pattern). Overall tethering degree was assessed by 3D tenting volume (volume from leaflets to annular plane).
The asymmetric group had a greater P/A ratio (3.19±0.88 vs. 1.95±0.46, P<0.01) compared to the symmetric group. MR severity (vena contracta) normalized to tenting volume was greater in the asymmetric group (0.38±0.24 vs. 0.19±0.13 cm/ml, P<0.01). Multivariate analysis showed that both P/A ratio ((β) =0.457, P<0.001) and tenting volume (β =0.411, P=0.001) were predictors of IMR.
IMR degree is affected by the pattern of tethering and not just total degree of tethering. For the same degree of tethering, an asymmetric pattern is associated with greater IMR compared to symmetric pattern. The pattern of mitral leaflet tethering may be considered in therapeutic decision making.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: Echo: Mitral Valve Imaging/RV Function
Abstract Category: 18. Imaging: Echo
Presentation Number: 1178-315
- 2013 American College of Cardiology Foundation