2015


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2015/№2

Mechanisms for development of ischemic mitral regurgitation

Chernyavsky A. M., Ruzmatov T. M., Efendiev V. U., Razumakhin R. A., Nesmachny A. S., Efanova O. S., Podsosnikova T. N., Volokitina T. L., Matveeva N. V., Prokhorova D. S.
Federal State Budgetary Institution, “Academician E.N. Meshalkin Novosibirsk Research Institute of Circulatory Pathology” of the RF Ministry of Health Care, Rechkunovskaya 15, Novosibirsk 630055

Keywords: coronary heart disease, ischemic mitral insufficiency, cardiomyopathy, heart failure

DOI: 10.18087/rhj.2015.2.1998

Background. Mechanisms for development of ischemic mitral regurgitation (IMR) in pronounced LV dysfunction and the relationship between the underlying mechanism and severity of mitral regurgitation (MR) have not been studied. Aim. To analyze results of the prospective, randomized study, which used data of transesophageal EchoCG (TEE), to determine mechanisms of MR in patients with pronounced LV dysfunction and IMR. Materials and methods. In the randomized study performed at the Novosibirsk Research Institute of Circulatory Pathology from 2005 through 2011, 230 patients with low LV EF and IMR of different severity were examined. The TEE study was used for evaluation of MR mechanisms and severity. Results. Geometry of the mitral valve (MV) and subvalvular structures and LV geometry and function were different in MR of different degrees. Analysis showed that no single, major mechanism of IMR development existed. A combination of several mechanisms induced by pathological LV remodeling is significant for the IMR pathogenesis – enlarged LV, increased interpapillary and annular-papillary distances, tension of MV leaflets, and expansion of the fibrous annulus.
  1. Grigioni F, Enriquez-Sarano M, Zehr KJ et al. Ishemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001 Apr 3;103 (13):1759–64.
  2. Grayburn PA, Appleton CP, DeMaria AN et al. Echocardiographic predictors of morbiditi and mortality in patients with advanced heart failure: the Beta-blocker Evaluation of Survival Trial (BEST). J Am Coll Cardiol. 2005 Apr 5;45 (7):1064–71.
  3. Trichon BH, Felker GM, Shaw LK et al. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol. 2003 Mar 1;91 (5):538–43.
  4. Rossi A, Dini FL, Faggiano P et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic cardiomyopathy. Heart. 2011 Oct;97 (20):1675–80.
  5. Deja MA, Grayburn PA, Sun B et al. Influence of mitral regurgitation repair on survival in the surgical treatment for ischemic heart failure trial. Circulation. 2012 May 29;125 (21):2639–48.
  6. Boltwood CM, Tei C, Wong M, Shah PM. Quantitative echocardiography of the mitral complex in dilated cardiomyopathy: the mechanism of functional mitral regurgitation. Circulation. 1983 Sep;68 (3):498–508.
  7. Kaul S, Pearlman JD, Touchstone DA, Esquival L. Prevalence and mechanisms of mitral regurgitation in the absence of intrinsic abnormalities of the mitral leaflets. Am Heart J. 1989 Nov;118 (5 Pt 1):963–72.
  8. Kono T, Sabbah HN, Rosman H et al. Left ventricular shape is the primary determinant of functional mitral regurgitation in heart failure. J Am Coll Cardiol. 1992 Dec;20 (7):1594–8.
  9. Levine RA, Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution from paradoxes to unifying concepts. Circulation. 2005 Aug 2;112 (5):745–58.
  10. He S, Fontaine AA, Schwammenthal E et al. Integrated mechanism for functional mitral regurgitation: leaflet restriction versus coap­ting force: in vitro studies. Circulation. 1997 Sep 16;96 (6):1826–34.
  11. Otsuji Y, Handschumacher MD, Schwammenthal E et al. Insights from three-dimensional echocardiography into the mechanism of functional mitral regurgitation: direct in vivo demonstration of altered leaflet tethering geometry. Circulation. 1997 Sep 16;96 (6):1999–2008.
  12. Otsuji Y, Gilon D, Jiang L et al. Restricted diastolic opening of the mitral leaflets in patients with left ventricular dysfunction: evidence for increased valve tethering. J Am Coll Cardiol. 1998 Aug;32 (2):398–404.
  13. Hung J, Otsuji Y, Handschumacher MD et al. Mechanism of dynamic regurgitation orifice area variation in functional mitral regurgitation: physiologic insights from the proximal flow convergence technique. J Am Coll Cardiol. 1999 Feb;33 (2):538–45.
  14. Kwan J, Shiota T, Agler DA et al. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation. 2003 Mar 4;107 (8):1135–40.
  15. Chin JH, Lee EH, Choi DK, Choi IC. The effect of depth of anesthesia on the severity of mitral regurgitation as measured by transesophageal echocardiography. J Cardiothorac Vasc Anesth. 2012 Dec;26 (6):994–9.
  16. Zoghbi WA, Enriquez-Sarano M, Foster E et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003 Jul;16 (7):777–802.
  17. Lancellotti P, Moura L, Pierard L et al. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr. 2010 May;11 (4):307–32.
  18. Чернявский А. М., Рузматов Т. М., Эфендиев В. У. и др. Влияние коронарного шунтирования и реконструкции левого желудочка на умеренную митральную недостаточность при хирургическом лечении ишемической болезни сердца с низкой фракцией выброса. Патология кровообращения и кардиохирургия. 2013;3:14–7.
Chernyavsky A. M., Ruzmatov T. M., Efendiev V. U. et al. Mechanisms for development of ischemic mitral regurgitation. Russian Heart Journal. 2015;14 (1):85–89

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