Abstract 19809: Association between Jet Direction and Mitral Leaflet Tethering in Ischemic Mitral Regurgitation. An Echocardiographic Study
Background: Mitral regurgitant (MR) jet direction with ischemic etiology is usually central to posterior. However, few studies revealed the cause of jet direction in ischermic MR. We hypothesized that in patients with ischemic MR, tethered mitral leaflets with the jet direction and the degree of tethering is associated with MR severity. Thus, relationship between leaflet configurations and direction and degree of ischemic MR was investigated.
Methods: In 116 patients with significant ischemic MR, tethering of AML or PML (α1 and α2), antero-posterior and baso-apical position of the coaptation (d1 and d2), and MR jet direction and MR severity were evaluated by 2-dimensional echocardiography (figure).
Results: 1) In patients with IMR, MR jet direction was central in 88 and posterior in 28 with the absence of anterior jet. 2) Patients with posterior MR jet had significantly greater MR jet width (5.8±0.9 vs. 3.7±1.3 mm, p<0.0001) and left ventricular dilatation. 3) Compared to patients with central MR jet, those with posterior MR jet had more severe tethering of both AML and PML (α1: 32 ± 7 vs. 37±10 degrees, p<0.01; α2: 53±10 vs. 62±10 degrees, p<0.005) and leaflet coaptation is posteriorly displaced (d1: 23.9± 4.2 vs. 26.0±4.1 mm, p<0.05) 4) The MR jet angle was significantly correlated with PML tethering angle (r=0.50, p<0.0001) and MR severity (r=0.56, p<0.0001). Multiple regression analysis identified α2 as the only independent determinant of MR jet angle (r=0.50, p<0.0001).
Conclusions: MR jet angle or direction toward posterior was associated with the tethering angle of the posterior mitral leaflet and MR severity in patients with ischemic MR.
- © 2010 by American Heart Association, Inc.