Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study

Flynn, Michael S.; Curtin, Ronan J.; Nowicki, Edward R.; Rajeswaran, Jeevanantham; Flamm, Scott D.; Blackstone, Eugene H.; Mihaljević, Tomislav

doi:10.1016/j.jtcvs.2008.12.023

Cited by 47 publications

(30 citation statements)

References 22 publications

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“…Many previous studies reported that patients undergoing surgery before developing contractile dysfunction and dilatation had better postoperative clinical outcomes in the short and long term than those with contractile deficiencies [[6], [9]]. Several techniques including magnetic resonance [10], deformation imaging [11] and biomarkers, such as brain natriuretic peptide [4], have been used for the early detection of contractile dysfunction. We hypothesized that the serum OPN level may be helpful in determining the timing of mitral valve surgery and may serve as a predictor of postoperative EF impairment.…”

Section: Discussionmentioning

confidence: 99%

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Güneş

Güler

et al. 2015

Cardiology

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Objective: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Methods: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Results: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Conclusion: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

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Section: Discussionmentioning

confidence: 99%

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Güneş

Güler

et al. 2015

Cardiology

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“…90,91 Therefore, CMR offers the potential to directly quantify RgV, RgF, and ROA in patients with MR. Because of its accuracy and precision in measuring LV volumes, CMR is useful for evaluation of LV remodeling in MR. 92 Finally, CMR can identify the presence of scar or fibrosis using delayed hyperenhancement of gadolinium contrast agents, a finding that may be particular relevant in FMR. 93,94 Limitations of CMR include cardiac arrhythmias that preclude adequate gating, pacemakers or implantable cardioverter-defibrillators, and claustrophobia. Direct measurement of ROA by CMR may be limited by slice thickness (typically 5 mm) and cardiac translation, which may render it difficult to align the image precisely with the narrowest part of the VCA.…”

Section: Role Of Exercise Testingmentioning

confidence: 99%

Quantitation of Mitral Regurgitation

2012

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“…Flynn et al recently reported the importance of papillary muscle scar burden to identify patients for whom annuloplasty alone is insufficient to prevent recurrent regurgitation. 29 Further investigation such as 3-dimensional analyses might be more informative to determine whether the precise amount or location of hyperenhancement tissue predicts adverse outcomes.…”

Section: Study Limitationsmentioning

confidence: 99%

Left Ventricular Basal Myocardial Scarring Detected by Delayed Enhancement Magnetic Resonance Imaging Predicts Outcomes After Surgical Therapies for Patients With Ischemic Mitral Regurgitation and Left Ventricular Dysfunction

Takeda

Matsumiya

Hamada

et al. 2011

Circ J

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Background: Treatment of heart failure by surgical procedures such as mitral annuloplasty and left ventricular (LV) restoration is increasingly applied to patients with ischemic mitral regurgitation (IMR) and LV dysfunction. The clinical efficacy of delayed enhancement magnetic resonance imaging (DE-MRI) was studied to predict LV functional recovery and adverse outcomes after these therapies. Methods and Results:In 26 patients with IMR and a LV ejection fraction <40%, DE-MRI was performed before the operation and the percentage of regional myocardial scarring was quantified at the basal, mid, and apical LV. Calculated percentage of fibrosis was 12±12% at the base, 24±15% at the mid, and 35±31% at the apical LV. The degree of basal fibrosis was a significant predictor of less improvement of LV ejection fraction and postoperative restrictive diastolic filling. A linear correlation was noted between basal fibrosis and postoperative ejection fraction (P=0.001, R=-0.61), the early to late mitral valve flow ratio (P=0.0005, R=0.66), and deceleration time (P=0.01, R=-0.51). Logistic regression analysis demonstrated that the percentage of basal fibrosis was the independent predictor of postoperative adverse clinical outcomes (odds ratio, 1.26; P=0.04). Conclusions:In patients undergoing surgical heart failure therapy for IMR, the extent of basal fibrosis characterized by DE-MRI might be a useful predictor of postoperative LV systolic and diastolic functional recovery and postoperative adverse outcomes. (Circ J 2011; 75: 148 - 156)

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Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study

Cited by 47 publications

References 22 publications

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Quantitation of Mitral Regurgitation

Left Ventricular Basal Myocardial Scarring Detected by Delayed Enhancement Magnetic Resonance Imaging Predicts Outcomes After Surgical Therapies for Patients With Ischemic Mitral Regurgitation and Left Ventricular Dysfunction

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