Relation of Mitral Annulus and Left Atrial Dysfunction to the Severity of Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy

Sorina Mihaila Baldea; Denisa Muraru; Marcelo Haertel Miglioranza; Sabino Iliceto; Dragos Vinereanu; Luigi Paolo Badano

doi:10.1155/2020/3261714

Relation of Mitral Annulus and Left Atrial Dysfunction to the Severity of Functional Mitral Regurgitation in Patients with Dilated Cardiomyopathy

Cardiol Res Pract. 2020 Jul 9:2020:3261714. doi: 10.1155/2020/3261714. eCollection 2020.

Authors

Sorina Mihaila Baldea¹, Denisa Muraru^{2

3}, Marcelo Haertel Miglioranza⁴, Sabino Iliceto⁵, Dragos Vinereanu¹, Luigi Paolo Badano^{2

3}

Affiliations

¹ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
² Istituto Auxologico Italiano IRCCS, Department of Cardiovascular Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.
³ University of Milano-Bicocca, Department of Medicine and Surgery, Milan, Italy.
⁴ Cardiology Institute of Rio Grande do Sul, Porto Alegre, Brazil.
⁵ University of Padua, Padua, Italy.

Abstract

Methods: 56 patients (58 ± 17 years, 42 men) with DCM and FMR and 52 controls, prospectively enrolled, underwent 3DTTE dedicated for mitral valve (MV), LA, and left ventricle (LV) quantitative analysis.

Results: Patients with FMR vs. controls presented increased MA size and sphericity during the entire systole, whereas MA fractional area change (MAFAC) and MA displacement were decreased (15 ± 5 vs. 28 ± 5%; and 5 ± 3 vs. 10 ± 2 mm, p < 0.001). In patients with moderate/severe FMR, MA diameters correlated with PISA radius, EROA, and regurgitant volume (Rvol), as also did the MA area (with PISA radius, EROA, and Rvol: r = 0.48, r = 0.58, and r = 0.47, p < 0.05). MAFAC correlated inversely with EROA and Rvol (r = -0.32 and r = -0.35, p < 0.05), with both active and total LA emptying fractions and with LV ejection fraction as well. In a stepwise multivariate regression model, decreased MAFAC and increased LA volume independently predicted patients with severe FMR.

Conclusions: Patients with DCM and FMR have MA geometry remodeling and contractile dysfunction, correlated with the severity of FMR. MA contractile dysfunction correlated with both LA and left LV pumps dysfunctions and predicted patients with severe FMR. Our results provide new insights that might help with better selection of patients for MV transcatheter procedures.