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

^a Department of CT Surgery, ISMETT, University of Pittsburgh Medical Center, Palermo, Italy
^b Office of Research and Biomedical Sciences, ISMETT, University of Pittsburgh Medical Center, Palermo, Italy
^c Department of Radiology, ISMETT, University of Pittsburgh Medical Center, Palermo, Italy

Received 4 April 2008; received in revised form 17 July 2008; accepted 28 July 2008.

^_* Corresponding author. Address: Department of CT Surgery, ISMETT – Mediterranean Institute for Transplantation and Advanced Specialized Therapies, UPMC – University of Pittsburgh Medical Center, Via Tricomi 1, 90127 Palermo, Italy. Tel.: +39 0912192111; fax: +39 0912192354. (Email: gdancona{at}ismett.edu).

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.

Key Words: Ischemic • Mitral • Regurgitation • MRI