Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study

• Published in: Circulation (New York, N.Y.) Vol. 107; no. 8; pp. 1135 - 1140
• Main Authors: Kwan, Jun, Shiota, Takahiro, Agler, Deborah A., Popovic, Zoran B., Qin, Jian Xin, Gillinov, Marc A., Stewart, William J., Cosgrove, Delos M., McCarthy, Patrick M., Thomas, James D.
• Format: Journal Article
• Language: English
• Published: Legacy CDMS Lippincott Williams & Wilkins 04.03.2003; American Heart Association, Inc
• Subjects: Biological and medical sciences; Cardiomyopathies - complications; Cardiomyopathy, Dilated - complications; Cardiovascular system; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional - methods; Female; Heart Ventricles - anatomy & histology; Heart Ventricles - diagnostic imaging; Humans; Investigative techniques, diagnostic techniques (general aspects); Life Sciences (General); Male; Medical sciences; Middle Aged; Mitral Valve - anatomy & histology; Mitral Valve - diagnostic imaging; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Myocardial Ischemia - complications; Ultrasonic investigative techniques; Ventricular Dysfunction, Left - diagnostic imaging; Mitral Valve/anatomy & Histology/ultrasonography; Human; Support, U.s. Gov't, Non-P.h.s; Nasa Discipline Cardiopulmonary; Comparative Study; Mitral Valve Insufficiency/etiology/ultrasonography; Middle Aged; Heart Ventricles/anatomy & Histology/ultrasonography; Non-Nasa Center; Male; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional/methods; Ventricular Dysfunction, Left/ultrasonography; Myocardial Ischemia/complications; Female; Cardiomyopathy, Congestive/complications; Evaluation Studies; Myocardial Diseases/complications; Sonography; Mitral valve; Echocardiography; Pathophysiology; Idiopathic; Cardiovascular disease; Exploration; Coronary heart disease; Myocardial disease; Vascular disease; Congestive hypertrophic cardiomyopathy; Ischemia; Cardiac valvular disease; Etiology; Heart disease; Morphological analysis; Mitral regurgitation; Myocardium; Tridimensional image; Hemodynamics; cardiomyopathy; Comparative study; NASA Discipline Cardiopulmonary; Non-NASA Center
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.0000053558.55471.2D

BACKGROUND: This study was conducted to elucidate the geometric differences of the mitral apparatus in patients with significant mitral regurgitation caused by ischemic cardiomyopathy (ICM-MR) and by idiopathic dilated cardiomyopathy (DCM-MR) by use of real-time 3D echocardiography (RT3DE). METHODS AND RESULTS: Twenty-six patients with ICM-MR caused by posterior infarction, 18 patients with DCM-MR, and 8 control subjects were studied. With the 3D software, commissure-commissure plane and 3 perpendicular anteroposterior (AP) planes were generated for imaging the medial, central, and lateral sides of the mitral valve (MV) during mid systole. In 3 AP planes, the angles between the annular plane and each leaflet (anterior, Aalpha; posterior, Palpha) were measured. In ICM-MR, Aalpha measured in the medial and central planes was significantly larger than that in the lateral plane (39+/-5 degrees, 34+/-6 degrees, and 27+/-5 degrees, respectively; P<0.01), whereas Palpha showed no significant difference in any of the 3 AP planes (61+/-7 degrees, 57+/-7 degrees, and 56+/-7 degrees, P>0.05). In DCM-MR, both Aalpha (38+/-8 degrees, 37+/-9 degrees, and 36+/-7 degrees, P>0.05) and Palpha (59+/-6 degrees, 58+/-5 degrees, and 57+/-6 degrees, P>0.05) revealed no significant differences in the 3 planes. CONCLUSIONS: The pattern of MV deformation from the medial to the lateral side was asymmetrical in ICM-MR, whereas it was symmetrical in DCM-MR. RT3DE is a helpful tool for differentiating the geometry of the mitral apparatus between these 2 different types of functional mitral regurgitation.