Ischemic mitral valve regurgitation in patients with depressed ventricular function: cardiac geometrical and myocardial perfusion evaluation with magnetic resonance imaging

Objective: To investigate geometrical and functional changes involving the left ventricle (LV) and mitral valve (MV) apparatus in patients with depressed LV ejection fraction (LVEF) and ischemic MV regurgitation (IMVR). Methods: A series of patients with three vessels coronary artery disease (CAD) and depressed LVEF underwent cardiac magnetic resonance imaging to investigate MV/LV geometry and function, and myocardial perfusion/vitality. Geometrical data were indexed by anterior MV leaflet length. Two groups were identified: CAD without IMVR (group CAD), and with IMVR (group IMV). Results: Eleven patients were enrolled in the CAD group and 13 in the IMV group. IMVR volume was significantly higher in the IMV group (24.0 +/- 12.0 vs 4.5 +/- 5.2; p < 0.0001). LVEF% was comparable (IMV 34.6 +/- 13.0 vs CAD 31.5 +/- 13.0; p = ns). Indexed MV/LV geometrical variables were comparable in the two groups. Perfusion/vitality study showed inferior myocardial necrosis occurred more often in the IMV group (p = 0.01). At Pearson test, MV regurgitation occurrence correlated with inferior myocardial necrosis (r = 0.5; p = 0.006), non-indexed systolic/diastolic annular inter-commissural diameters (r = 0.4; p = 0.04) and MV annular areas (r = 0.4; p = 0.04). Papillary muscles distance (PMD) and LV volumes inversely correlated with LVEF% (r = -0.6; p < 0.05 and r = -0.8; p < 0.001). At multivariable analysis, no independent determinants for IMVR were identified and LV volumes were the sole determinants for LVEF% (p < 0.05). Conclusion: In patients with depressed LVEF%, IMV cannot be explained by LV geometrical modifications alone. Although PMD, LV volumes, and LVEF% are correlated, they have no direct impact in the development of IMVR. In contrast, inferior myocardial necrosis and increased inter-commissural MV diameters may lead to deformity of MV complex and subsequent IMV. (c) 2008 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.