Novel Echocardiographic Indices as Predictors of Immediate Recurrence after Undersized Ring Annuloplasty for Ischemic Mitral Regurgitation

Abstract

Background and aim: Ischemic mitral regurgitation (IMR) is among the most serious complications of myocardial infarction which doubles the late mortality; mainly treated by undersizing ring annuloplasty. To find some preoperative echocardiographic indices that predict immediate failure of mitral valve annuloplasty (MVA), we designed the present study with more focusing on some novel parameters. Method: Transthoracic echocardiography (TTE) indices of consecutive patients referred with 3+ or 4+ IMR were registered 24 hours before surgery. Thirty days later, a second TTE was performed. According to the results, the patients were categorized as the "successful" group (with 1+ or less mitral regurgitation) and the "unsuccessful" group (with 2+ or higher MR). Preoperative TTE indices were compared among the two groups using suitable statistical tests. Results: Of the total of 126 cases, 68 had successful and 58 had unsuccessful MVA. Statistically significant differences were found between the two groups for left ventricular ejection fraction (LVEF) (P = 0.007), left ventricular end systolic volume (LVESV) (P = 0.044), and basal-interpapillary muscle distance (IPMD) diastolic-to-systolic ratio (DSR) (P = 0.008). Receiver Operating Characteristic analysis demonstrated 37.5%, 3.85 cm 3 , and 1.25, as the best cutoff points for LVEF (P = 0.03, sensitivity: 81%, specificity: 69%), LVESV (P = 0.023, sensitivity: 83%, specificity: 57%), and basal-IPMD DSR (P = 0.001, sensitivity: 100%, specificity: 95%), respectively. Conclusion: Among all TTE indices, LVEF, LVESV, and basal-IPMD DSR were helpful to differentiate between the successful and unsuccessful MVA results. We believe the basal-IPMD DSR as a novel index could be targeted in the future studies. (Echocardiography 2015;32:1339-1346

The value of preoperative 3-dimensional over 2-dimensional valve analysis in predicting recurrent ischemic mitral regurgitation after mitral annuloplasty

“…Studies reporting on preoperative 2DE predictors of IMR recurrence after annuloplasty show inconsistent, frequently nonreproducible, and sometimes conflicting results (Table 4). 6, 13–34 Some studies identify certain valvular, subvalvular, ventricular, or functional 2DE parameters as independent predictors, whereas the same predictors are not found to be predictive in other studies. 6, 13–34 The current study clearly demonstrates the influence of viewing plane selection.…”

“…6, 13–34 Some studies identify certain valvular, subvalvular, ventricular, or functional 2DE parameters as independent predictors, whereas the same predictors are not found to be predictive in other studies. 6, 13–34 The current study clearly demonstrates the influence of viewing plane selection. Two-dimensional tethering parameters measured in the 2-chamber view are predictive of IMR recurrence, whereas the same 2-dimensional tethering parameters measured in the 4-chamber view are not predictive.…”

“…6, 13–34 To improve patient selection and postoperative outcome, we sought to determine the incremental value of preoperative 3DE and advanced mitral valve modeling over 2DE in predicting recurrent IMR after mitral annuloplasty. We recently published the 3DE results of 50 patients with IMR, 10 and to determine the incremental value of 3DE over 2DE, we performed additional 2DE analyses in this same group of 50 patients.…”

A Surgical Perspective on Ischemic Mitral Regurgitation: Tethering or Prolapse? Going Back to Papillary Muscles Anatomy. What the Surgeons Really Need to Know

“…However, general results of valve repair in IMR remain frustrating dropping a veil of uncertainty on the actual benefit of this type of surgery [2]- [4]. Success of mitral repair relies on the comprehension of both the geometric modifications of the annulus and the morphology and physiopathology of papillary muscle (PM) [5].…”