Document Detail

Different influences of left ventricular remodeling on anterior and posterior mitral leaflet tethering.
MedLine Citation:
PMID:  22785152     Owner:  NLM     Status:  MEDLINE    
BACKGROUND:  Different influences of left ventricular (LV) remodeling on anterior and posterior mitral leaflet (AML and PML) tethering in ischemic mitral regurgitation (MR) has not been fully investigated. We hypothesized that progressive outward displacement of papillary muscles, including posterior vector, may cause greater tethering to PML compared to AML.
METHODS AND RESULTS:  In 79 patients with LV ejection fraction <50% and 20 controls, LV sphericity, AML and PML tethering angles, apical and posterior displacement of coaptation, mitral annular area, and severity of MR (vena contracta width) were measured using 3-D echocardiography. To examine different influences of LV remodeling on AML and PML tethering, interaction between AML/PML and LV sphericity was tested using multiple regression analysis. Both AML and PML tethering significantly increased with increased LV sphericity (r=0.59 and 0.65, P<0.001). Multiple regression yielded a significant interaction term between AML vs. LV sphericity and PML vs. LV sphericity (t=3.69, P<0.001), indicating greater influence from LV remodeling on PML compared to that for the AML. Multivariate analysis demonstrated independent contributions to MR severity from PML tethering primarily along with posterior and apical displacement of coaptation.
CONCLUSIONS:  LV remodeling augments tethering of both AML and PML, with greater influence on PML. 
Hiromi Nakai; Kyoko Kaku; Masaaki Takeuchi; Kyoko Otani; Hidetoshi Yoshitani; Nobuhiko Haruki; Masahito Tamura; Masahiro Okazaki; Haruhiko Abe; Akizumi Tsutsumi; Robert A Levine; Yutaka Otsuji
Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-06-21
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  76     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2012  
Date Detail:
Created Date:  2012-09-25     Completed Date:  2013-02-14     Revised Date:  2013-02-19    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  2481-7     Citation Subset:  IM    
Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Iseigaoka, Yahatanishi-ku, Kitakyushu 807-8555, Japan.
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MeSH Terms
Echocardiography, Three-Dimensional*
Middle Aged
Mitral Valve / physiopathology*,  ultrasonography*
Ventricular Remodeling*
Grant Support

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