Author + information
- Toshiyuki Kimura,
- Nozomi Watanabe,
- Sergio Barros-Gomes,
- Veronique Roger and
- Maurice Enriquez-Sarano
Background: Ischemic mitral regurgitation (IMR) when chronic, involves flat and adynamic mitral annulus but IMR mechanisms in acute myocardial infarction (MI) are not known.
Methods: We prospectively performed 3D echocardiography (3DE) 1.8±1.0 days after a first MI, in 2 groups of consecutive patients: IMR (n=39) and no MR (n=39), matched on age, sex and Troponin T value. Left ventricular (LV) volumes were measured by 3DE and mitral apparatus dynamics quantified using custom 3D software in diastole and early-, mid- and late-systole.
Results: Acute IMR was associated with mitral apparatus alterations appearing early after the first MI, with larger and flatter annulus and increased valvular tenting. However, contrary to chronic IMR, in acute IMR the mitral annulus remained dynamic (Figure). Sub-valvular changes with greater Inter papillary muscle (PM) width in diastole and mid-systole were present with greater valvular tenting in acute IMR, despite similar LV volumes and ejection fraction.
Conclusions: Prospective 3DE reveals distinct changes associated with IMR in incident MI. Unlike chronic IMR, acute IMR is not due to marked LV enlargement or adynamic annulus but involves specific alterations of annular, valvular and sub-valvular mitral apparatus. The larger and flatter annulus remains dynamic and with wider spread of PMs, leads to excessive tenting and IMR. The specific dynamic changes of mitral apparatus in patients with acute IMR should be considered in novel treatment strategies.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: New Technologies in Echocardiography
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1245-216
- 2017 American College of Cardiology Foundation