Background
Ischemic mitral regurgitation (IMR) develops as a result of mitral valve annular dilatation or stretching of mitral leaflet chordae due to remodeling of the left ventricle (LV), without structural defects in the mitral apparatus.The purpose of this study was to validate the role of three dimensional (3D) transesophageal echocardiography (TEE) in assessing anatomical predictors and mechanism behind IMR.
Method(s)
A total of 54 patients with IMR underwent 2D transthoracic echocardiography (2DTTE), 2DTEE and 3DTEE. IMR was evaluated by the PISA method; EROA, regurgitation fraction (RF) and regurgitation volume (RV), measured with both 2DTEE and 3DTEE. LV sphericity index (SI) and apical conicity index (CI), mitral anterolateral (AL)/posteromedial (PM) tethering length (TL), and coaptation length (CL) were measured with 2DTTE.
Result(s)
Majority of the patients had previous anterior MI (57%). In the whole group comprises both anterior and non-anterior MI’s, functional severity as assessed by RF-3DTEE showed strong correlations with anatomical parameters (SIdiastole [r=0.477, p= 0.001], SIsystole [r= 0.395, p= 0.006] and PM TL [r=0.366, p= 0.011]). EROA-3DTEE (r= 0.588, p= 0.008) and RV-3DTEE (r= 0.602, p= 0.006) controlled by EDV-3DTEE showed significant correlations with PM TL in non-anterior MI patients. EROA-2DTEE and RV-2DTEE were not correlated with any of the anatomical parameters after controlling of EDV-2D. 3DTEE-derived parameters [(EROA: r= 0.503, p<0.001), (RV: r= 0.631, p<0.001) and (RF: r= 0.567, p<0.001)] were much more strongly associated with left atrial volume compared to 2DTEE-derived parameters. Pulmonary artery pressure was strongly associated with 3DTEE-derived EROA (r= 0.571, p<0.001), RV (r= 0.455, p= 0.001) and RF (r= 0.501, p<0.001). SIdiastole was also more strongly correlated with 3DTEE-derived parameters of MR [(EROA: r= 0.378, p=0.005), (RV: r= 0.477, p<0.001) and (RF: r= 0.477, p=0.001)] than 2DTEE-derived parameters.
Conclusion(s)
These study suggest the superiority of 3DTEE over 2DTEE in predicting structural abnormalities that underlie IMR.

Impact of 3D transesophageal echocardiography in predicting structural abnormalities that underlie ischemic mitral regurgitation

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.