| Elevated left atrial pressure estimated by Doppler echocardiography is a key determinant of mitral valve tenting in functional mitral regurgitation. | |
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MedLine Citation:
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PMID: 20194204 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Functional mitral regurgitation (FMR) may occur in patients with reduced or preserved left ventricular ejection fraction (LVEF) and has been associated with excess valvular tenting only in patients with reduced LVEF. This study aimed at identifying the predictors of FMR and to determine whether or not they are different in patients with reduced versus preserved LVEF. METHODS: 190 consecutive patients free of congenital or primary valvular disease had a comprehensive echocardiographic assessment of LV remodelling and function, diastolic function and FMR severity. RESULTS: 112 patients had depressed LVEF (<50%) and 78 had preserved LVEF. FMR was present in 30 patients with preserved LVEF and in 65 with reduced LVEF. Higher E/Ea, E/A and larger mitral tenting were independent predictors of FMR regardless of LVEF. The mitral tenting area was an independent predictor of FMR severity in patients with reduced or preserved LVEF (p = 0.04 and p = 0.0045) in addition to E/A (p = 0.0007), E/Ea (p = 0.004) in patients with reduced and preserved LVEF, respectively. Higher E/Ea was independently associated with larger mitral tenting in patients with reduced and preserved LVEF. Mitral tenting area was linearly related to E/Ea (r = 0.30, p<0.0001) and E/A (r = 0.43, p<0.0001) and LA enlargement (r = 0.54, p<0.0001) after having paired 96 patients with and without FMR on indices of LV remodelling. CONCLUSIONS: In both patients with preserved and reduced LVEF, mitral tenting that leads to FMR is mainly determined by both mitral tethering forces-that is, displacement of papillary muscles and by pushing forces-that is, increased left atrial pressure. This study underscores that LV preload is a key determinant of FMR. |
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Authors:
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S Mar?chaux; C Pin?on; M Poueymidanette; M Verhaeghe; A Bellouin; P Asseman; T Le Tourneau; T H Lejemtel; P Pibarot; P V Ennezat |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 96 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-03-02 Completed Date: 2010-04-09 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 289-97 Citation Subset: AIM; IM |
Affiliation:
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Centre Hospitalier R?gional et Universitaire de Lille, Department of Ultrasound and Physiology, Lille, France. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Pressure / physiology Echocardiography, Doppler Female Humans Male Middle Aged Mitral Valve / surgery Mitral Valve Insufficiency / physiopathology, surgery, ultrasonography* Retrospective Studies Stroke Volume Ventricular Dysfunction, Left / physiopathology, ultrasonography* Ventricular Remodeling |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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