Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: Data from the Acorn trial

Seong-Mi Park, Seung Woo Park, Grace Casaclang-Verzosa, Steve R. Ommen, Patricia A. Pellikka, Fletcher A. Miller, Maurice E. Sarano, Spencer H. Kubo, Jae K. Oh

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Abstract

Background: Functional mitral regurgitation (MR) is commonly seen in dilated cardiomyopathy (DCM), which may result from left ventricular (LV) dilatation and alteration in the geometric relationship of mitral valve apparatus. However, not all patients with DCM show significant MR and left atrial (LA) enlargement. The aim of this study was to assess responsible factors for developing mitral valve regurgitation. Methods: Of 300 patients enrolled in the Acorn trial, baseline echocardiography studies were available in 288, of whom 144 were excluded because of a variety of reasons. Echocardiographic data were examined for the remaining 144 patients in sinus rhythm with DCM, but without organic mitral valve disease and ischemic heart disease. Mitral regurgitation was assessed by color-flow imaging. All echocardiographic parameters were indexed to body surface area. Results: Of 144 patients, 87 had MR grade ≥2 (group 1) and 57 had MR grade 0 or +1 (group 2). Group 1 had larger tenting area, tenting height, tethering distance, LA volume index, and mitral annular area than group 2 (all P < .001); LV volume index and ejection fraction were similar between groups. The major determinant of MR severity was tenting area (r = 0.49, P < .001), and this was best related to mitral annular area (r = 0.85, P < .001). Mitral annular area was most strongly associated with LA volume (r = 0.56, P < .001). In addition, LA volume index was highly correlated with LV diastolic dysfunction (r = 0.58, P < .001), both in total and in group 2 only. Conclusions: For patients with DCM in the Acorn trial, MR severity was associated with LA volume and mitral annular area but not with LV volume. Mitral annular area and LA volume were closely related, even in patients without significant MR. These findings suggest that LA enlargement caused by advanced diastolic dysfunction may contribute to causing significant MR by augmenting mitral annular dilatation in DCM.

Original languageEnglish
JournalAmerican Heart Journal
Volume157
Issue number4
DOIs
Publication statusPublished - 2009 Apr 1

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Dilated Cardiomyopathy
Mitral Valve Insufficiency
Mitral Valve
Dilatation
Body Surface Area
Left Ventricular Dysfunction
Myocardial Ischemia
Echocardiography
Color

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy : Data from the Acorn trial. / Park, Seong-Mi; Park, Seung Woo; Casaclang-Verzosa, Grace; Ommen, Steve R.; Pellikka, Patricia A.; Miller, Fletcher A.; Sarano, Maurice E.; Kubo, Spencer H.; Oh, Jae K.

In: American Heart Journal, Vol. 157, No. 4, 01.04.2009.

Research output: Contribution to journalArticle

Park, Seong-Mi ; Park, Seung Woo ; Casaclang-Verzosa, Grace ; Ommen, Steve R. ; Pellikka, Patricia A. ; Miller, Fletcher A. ; Sarano, Maurice E. ; Kubo, Spencer H. ; Oh, Jae K. / Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy : Data from the Acorn trial. In: American Heart Journal. 2009 ; Vol. 157, No. 4.
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abstract = "Background: Functional mitral regurgitation (MR) is commonly seen in dilated cardiomyopathy (DCM), which may result from left ventricular (LV) dilatation and alteration in the geometric relationship of mitral valve apparatus. However, not all patients with DCM show significant MR and left atrial (LA) enlargement. The aim of this study was to assess responsible factors for developing mitral valve regurgitation. Methods: Of 300 patients enrolled in the Acorn trial, baseline echocardiography studies were available in 288, of whom 144 were excluded because of a variety of reasons. Echocardiographic data were examined for the remaining 144 patients in sinus rhythm with DCM, but without organic mitral valve disease and ischemic heart disease. Mitral regurgitation was assessed by color-flow imaging. All echocardiographic parameters were indexed to body surface area. Results: Of 144 patients, 87 had MR grade ≥2 (group 1) and 57 had MR grade 0 or +1 (group 2). Group 1 had larger tenting area, tenting height, tethering distance, LA volume index, and mitral annular area than group 2 (all P < .001); LV volume index and ejection fraction were similar between groups. The major determinant of MR severity was tenting area (r = 0.49, P < .001), and this was best related to mitral annular area (r = 0.85, P < .001). Mitral annular area was most strongly associated with LA volume (r = 0.56, P < .001). In addition, LA volume index was highly correlated with LV diastolic dysfunction (r = 0.58, P < .001), both in total and in group 2 only. Conclusions: For patients with DCM in the Acorn trial, MR severity was associated with LA volume and mitral annular area but not with LV volume. Mitral annular area and LA volume were closely related, even in patients without significant MR. These findings suggest that LA enlargement caused by advanced diastolic dysfunction may contribute to causing significant MR by augmenting mitral annular dilatation in DCM.",
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AU - Park, Seung Woo

AU - Casaclang-Verzosa, Grace

AU - Ommen, Steve R.

AU - Pellikka, Patricia A.

AU - Miller, Fletcher A.

AU - Sarano, Maurice E.

AU - Kubo, Spencer H.

AU - Oh, Jae K.

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