Valvular Heart DiseaseMechanisms of Functional Mitral Regurgitation in Ischemic Cardiomyopathy Determined by Transesophageal Echocardiography (from the Surgical Treatment for Ischemic Heart Failure Trial)
Section snippets
Methods
All participating STICH study sites were invited to participate in the STICH MR TEE substudy; 17 accepted. All 17 sites were provided with a detailed study protocol for obtaining TEE images to define the mechanism and severity of functional MR.17, 18, 19 An Institutional Review Board approval was obtained from each site, and written informed consent was obtained from all patients. At the time the STICH trial was initiated, real-time 3D imaging was not available. Sites equipped with a Philips
Results
TEE studies were obtained in 214 subjects; of whom, 81 had both 2D and 3D TEEs performed and 134 had only 2D TEE. Of these, 210 studies (97.7%) were of sufficient quality to assess MR severity. There were 57 patients with no MR, 120 with mild, 29 with moderate, and 4 with severe MR. Of the subset of patients with 3D TEE, 26 had no MR, 44 had mild MR, and 11 had moderate or severe MR. Given the small sample of severe MR and the fact that even moderate MR portends a poor prognosis in heart
Discussion
It has been well accepted that in ischemic cardiomyopathy, functional MR is primarily caused by LV dilation and/or dysfunction, such that coaptation of normal or nearly normal mitral leaflets is prevented by a combination of reduced systolic closing force, leaflet tethering, and mitral annular dilation. This ancillary study of the STICH trial offered the opportunity to systematically assess many of these variables using high-resolution measurements of the mitral leaflets and annulus by TEE. The
Disclosures
E.J.V. and P.A.G. report research grants with Abbott Vascular; no other conflicts of interest to report regarding this manuscript.
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This work was supported by grants RO1HL72430, UO1HL69015, and UO1HL60913 from the National Institutes of Health, Bethesda, Maryland.
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