The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study.
Acute Disease
Aged
Chronic Disease
Echocardiography, Four-Dimensional
/ methods
Female
Heart Ventricles
/ diagnostic imaging
Humans
Male
Middle Aged
Mitral Valve
/ diagnostic imaging
Mitral Valve Insufficiency
/ diagnostic imaging
Myocardial Infarction
/ complications
Papillary Muscles
/ diagnostic imaging
Prospective Studies
Ventricular Remodeling
3D echocardiography
acute myocardial infarction
left ventricle
mitral regurgitation
Journal
European heart journal. Cardiovascular Imaging
ISSN: 2047-2412
Titre abrégé: Eur Heart J Cardiovasc Imaging
Pays: England
ID NLM: 101573788
Informations de publication
Date de publication:
01 04 2019
01 04 2019
Historique:
received:
26
04
2018
revised:
27
09
2018
accepted:
31
10
2018
pubmed:
6
12
2018
medline:
10
9
2019
entrez:
6
12
2018
Statut:
ppublish
Résumé
Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. We prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01). 3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.
Identifiants
pubmed: 30517693
pii: 5230888
doi: 10.1093/ehjci/jey177
pmc: PMC6429236
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
396-406Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL120957
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : ErratumIn
Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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