Local Dysfunction and Asymmetrical Deformation of Mitral Annular Geometry in Ischemic Mitral Regurgitation: A Novel Computerized 3D Echocardiographic Analysis

Daimon, Masao; Saracino, Giuseppe; Gillinov, A. Marc; Koyama, Yasushi; Fukuda, Shota; Kwan, Jun; Song, Jong Min; Kongsaerepong, Vorachai; Agler, Deborah A.; Thomas, James D.; Shiota, Takahiro

doi:10.1111/j.1540-8175.2007.00600.x

Cited by 47 publications

(38 citation statements)

References 30 publications

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“…The availability of this software sparked new research aimed at improved characterization of the mechanisms leading to mitral regurgitation. [75][76][77][78] Recent studies characterizing the mitral valve apparatus in nonischemic and ischemic cardiomyopathy have demonstrated geometric differences in mitral annular deformation with increased intercommissural and anteroposterior dimensions compared with healthy individuals, coupled with increased leaflet tenting and cordal tethering. 79 -81 Similarly, in patients with MI, the mitral annulus was found to be more dilated and flattened and further deformed in anterior versus posterior infarction.…”

Section: Mor-avi Et Almentioning

confidence: 99%

“…In contrast, in patients with ischemic mitral regurgitation, LV remodeling caused by abnormal inferior wall motion results in uneven papillary muscle displacement and asymmetrical localized tethering associated with eccentric mitral regurgitation. 78,84 In addition, the characteristics of the mitral annular function were compared between patients with hypertrophic cardiomyopathy and LV hypertrophy secondary to hypertension or aortic stenosis. 87 Annular function in the LV hypertrophy group was similar to that of normal control subjects, whereas annular apical-basal motion and annular area changes were reduced in hypertrophic cardiomyopathy.…”

Section: Mor-avi Et Almentioning

confidence: 99%

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Real-Time 3-Dimensional Echocardiography

2009

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O ne of the most significant developments of the last decade in ultrasound imaging of the heart was the evolution of 3-dimensional (3D) imaging from slow and labor-intense offline reconstruction to real-time volumetric imaging. This imaging modality provides valuable clinical information that empowers echocardiographers with new levels of confidence in the diagnosis of heart disease. We have previously described the technological milestones in the development of real-time 3D echocardiographic (RT3DE) imaging and its major advantages over conventional 2-dimensional echocardiography (2DE) and reviewed the published literature that supported the use of this new methodology in clinical practice. 1 Since 2006, the growing availability of RT3DE technology, its ease of use, and its multiple attractive features have sparked significant interest in the research community, resulting in a large number of publications, most of which have endorsed RT3DE imaging for clinical use by demonstrating its unique capabilities in different scenarios. In parallel, the clinical acceptance of this new tool has broadened significantly. The most recent clinically significant addition is matrix-array transesophageal echocardiography (TEE), which provides images of unprecedented quality that aid surgeons and interventional cardiologists in planning and guiding procedures and evaluating their outcomes.The purpose of the present article is to review the most recent RT3DE literature and provide readers with an update on the latest developments and the current status of this noninvasive imaging tool. Because different potential applications of RT3DE imaging have been explored to various extents, they are described here separately, and each is discussed with an emphasis on the scientifically established facts, along with the known stumbling blocks and difficulties. Quantification of LV Volumes and FunctionA firmly established advantage of 3D imaging over crosssectional slices of the heart is the improvement in the accuracy of the evaluation of left ventricular (LV) volumes and ejection fraction (EF) by eliminating the need for geometric modeling, which is inaccurate in the presence of aneurysms, asymmetrical ventricles, or wall motion abnormalities, and the errors caused by foreshortened views even in symmetrical ventricles. The value of RT3DE imaging in this context has been demonstrated by multiple studies that compared RT3DE volume measurements with widely accepted reference techniques, including radionuclide ventriculography and cardiac magnetic resonance (CMR). [2][3][4][5][6] These studies and others have demonstrated higher levels of agreement between the RT3DE approach and the respective reference technique compared with conventional 2DE methodology. Additionally, RT3DE measurements were found to be more reproducible than 2DE 4,5,7 and, in some studies, even as reproducible as CMR. 8 Interestingly, in a recent study in patients after myocardial infarction (MI), 9 RT3DE-derived LV volumes were more accurate and more reproducible than thos...

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Section: Mor-avi Et Almentioning

confidence: 99%

Section: Mor-avi Et Almentioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography

2009

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“…Using three-dimensional (3D) echocardiography, Daimon et al [23] showed that annular dilation results in annular asymmetry during systole [24]. Furthermore, changes in annular motion are asymmetric, implying a role for regional LV dysfunction causing alterations in annular geometry that result in IMR.…”

Section: Pathophysiologymentioning

confidence: 98%

Ischemic mitral regurgitation

Krishnaswamy¹,

Gillinov²,

Griffin³

2011

Coronary Artery Disease

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Secondary or 'functional' mitral regurgitation (MR) is often due to ischemic heart disease that results in disordered left ventricle and mitral valve geometry. In patients with coronary disease, concomitant MR results in worse morbidity and mortality. Coronary artery disease may result in annular dilation due to left ventricle cavity dilation, excessive leaflet motion, impaired leaflet motion due to leaflet tethering and papillary muscle displacement, and/or decreased mitral valve closing forces due to systolic dysfunction. Although transthoracic echocardiography is the first step in the diagnosis of ischemic MR, transesophageal and three-dimensional echocardiography are often useful adjuncts to better understand the mechanism(s) of disease and planning repair. Furthermore, noninvasive evaluation of ischemia and viability may provide important prognostic information. Medical therapy for ischemic MR is directed at the underlying ischemic substrate and concomitant systolic dysfunction, and consists of β-blockers and vasodilators. Percutaneous strategies for repair are currently under investigation, and have shown promising results. Surgical repair is favored over replacement, and is generally recommended for patients with moderate or severe MR undergoing coronary artery bypass. Unfortunately, long-term freedom from MR is elusive even with surgical repair, and trials are currently underway to determine the best approach to treatment in patients with moderate disease.

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“…RT3D echocardiography has proven that in patients with functional mitral regurgitation due to dilated cardiomyopathy, symmetrical papillary muscle displacement leads to progressive cordal tethering and leafl et tenting, resulting in predominantly central mitral regurgitation as a result of decreased leafl et coaptation [38,39•,40]. On the other hand, in patients with ischemic mitral regurgitation, left ventricular remodeling caused by abnormal wall motion results in uneven papillary displacement and asymmetric tethering associated with eccentric mitral regurgitation [38,41,42]. It is well known that functional mitral regurgitation is a poor prognostic predictor in patients with left ventricular dysfunction [43][44][45].…”

Section: Assessment Of Mitral Valve Tenting In Functional Mitral Regumentioning

confidence: 98%

Real-time three-dimensional echocardiographic evaluation of the mitral valve

Obase

Watanabe²,

Yoshida³

2009

curr cardiovasc imaging rep

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The three-dimensional (3D) echocardiographic system allows us to visually understand the confi guration of the complex mitral valve morphology, which consists of the saddle-shaped annulus, leafl ets, chordae, and papillary muscles. The recent development of transesophageal real-time 3D echocardiography has led to important advances in the diagnosis of mitral valve disease. Furthermore, the reconstructed 3D images can be quantitatively measured and analyzed in 3D spaces. These observations provide us important additional information in the clinical diagnosis of mitral valve diseases.

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Local Dysfunction and Asymmetrical Deformation of Mitral Annular Geometry in Ischemic Mitral Regurgitation: A Novel Computerized 3D Echocardiographic Analysis

Abstract: This novel 3D echo method demonstrated that MA motion and dilatation were asymmetric in IMR and symmetric in DMR. These differences in MA geometry and motion may aid in the development of distinct new therapies for IMR and DMR.

Cited by 47 publications

References 30 publications

Real-Time 3-Dimensional Echocardiography

Real-Time 3-Dimensional Echocardiography

Ischemic mitral regurgitation

Real-time three-dimensional echocardiographic evaluation of the mitral valve

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