Mechanisms of functional mitral regurgitation in ischemic cardiomyopathy determined by transesophageal echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial).

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Citation: American Journal of Cardiology. 112(11):1812-8, 2013 Dec 1.PMID: 24035166Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, N.I.H., ExtramuralSubject headings: *Cardiomyopathies/us [Ultrasonography] | *Mitral Valve Insufficiency/us [Ultrasonography] | *Mitral Valve/us [Ultrasonography] | *Myocardial Ischemia/us [Ultrasonography] | Aged | Cardiomyopathies/et [Etiology] | Echocardiography, Three-Dimensional | Echocardiography, Transesophageal | Female | Humans | Male | Middle Aged | Mitral Valve Insufficiency/et [Etiology] | Multivariate Analysis | Myocardial Ischemia/co [Complications] | Prospective Studies | Severity of Illness Index | Stroke VolumeYear: 2013Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0002-9149
Name of journal: The American journal of cardiologyAbstract: The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR. Copyright 2013 Elsevier Inc. All rights reserved.All authors: Asch FM, Aston S, Cherniavsky A, Drozdz J, Golba K, Grayburn PA, Haddad H, Handschumacher MD, Holly TA, Horton J, Kron I, Lee KL, Maurer G, Mokrzycki K, Przybylski R, Roberts BJ, Schaff H, STICH TEE Substudy Investigators, Velazquez EJ, Wrobel K, Yii MFiscal year: FY2014Digital Object Identifier: Date added to catalog: 2014-04-04
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 24035166 Available 24035166

Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006

The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR. Copyright 2013 Elsevier Inc. All rights reserved.

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