Role of echocardiography in the diagnosis and prognosis of patients with mitral regurgitation

Current Opinion in Cardiology

Volumn 18, Issue 5, 2003, Pages 334-339

  Aikat, Shamik ^a   Lewis, Jannet F ^a,b  

^a GEORGE WASHINGTON UNIVERSITY MEDICAL CENTER   (United States)

^b GEORGE WASHINGTON UNIVERSITY   (United States)

Author keywords

Echocardiography; Mitral disease; Mitral regurgitation

Indexed keywords

CLINICAL TRIAL; HUMAN; MEDICAL LITERATURE; MITRAL VALVE REGURGITATION; MITRAL VALVE REPLACEMENT; PRIORITY JOURNAL; PROGNOSIS; QUANTITATIVE ANALYSIS; REVIEW; THREE DIMENSIONAL ECHOCARDIOGRAPHY; TRANSESOPHAGEAL ECHOCARDIOGRAPHY;

ECHOCARDIOGRAPHY; ECHOCARDIOGRAPHY, THREE-DIMENSIONAL; ECHOCARDIOGRAPHY, TRANSESOPHAGEAL; HUMANS; MITRAL VALVE; MITRAL VALVE INSUFFICIENCY; PREOPERATIVE CARE; PROGNOSIS;

EID: 0141453163     PISSN: 02684705     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001573-200309000-00002     Document Type: Review

References (20)

1. Otto CM: Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001, 345:740-746.
2. Otto C: Timing of surgery in mitral regurgitation. BMJ Heart 2003, 89:100-115. This article reviews the pivotal role of echocardiography in the time of surgical intervention and the determination of whether repair is feasible.
3. Meier DJ, Landolfo CL, Starlin MR: The role of echocardiography in the timing of surgical intervention for chronic aortic and mitral regurgitation. In The Practice of Clinical Echocardiography, edn 2. Edited by Otto CM. Philadelphia: WB Saunders; 2002:389-416.
4. Omran AS, Woo A, David TE, et al.: Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and suitability for repair. J Am Soc Echocardiogr 2002, 15:950-957. A total of 170 patients undergoing repair with mitral prolapse or flail leaflet and intraoperative transesophageal echocardiography are reported. Mitral valve repair was successful in 91% of patients. The lowest success rate occurred in patients with extensive disease of both leaflets. Independent predictors of unsuccessful repair included central mitral regurgitant jet, calcification or severe dilation of the mitral annulus, and disease involving both anterior and posterior mitral leaflets with involvement of three or more segments.
5. Grigioni F, Enriquez-Sarano M, Ling LH, et al.: Sudden death in mitral regurgitation due to flail leaflet. J Am Coll Cardiol 1999, 34:2078-2085.
6. Colombo PC, Wu RH, Weiner S, et al.: Value of quantitative analysis of mitral regurgitation jet eccentricity by color flow Doppler for identification of flail leaflet. Am J Cardiol 2001, 88:534-540.
7. Thomas L, Foster E, Hoffman JI, et al.: Prospective validation of an echocardiographic index for determining the severity of chronic mitral regurgitation. Am J Cardiol 2002, 90:607-612. The mitral regurgitation index (the composite of six echocardiographic variables:jet penetration, proximal isovelocity surface area, continuous-wave Doppler characteristics of regurgitant jet, pulmonary artery pressure, pulmonary venous flow pattern, and left atrial size) was tested in 62 patients. Comparison with regurgitant fraction and effective regurgitant orifice showed good correlation. A mitral regurgitation index of 2.2 or more had a sensitivity of 82% and a specificity of 98% for severe mitral regurgitation. No patient with mild mitral regurgitation had a score of more than 1.67.
8. Enriquez-Sarano M, Miller FA Jr, Hayes SN, et al.: Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 1995, 25:703-709.
9. Rokey R, Sterling LL, Zoghbi WA, et al.: Determination of regurgitant fraction in isolated mitral or aortic regurgitation by pulsed Doppler two-dimensional echocardiography. J Am Coll Cardiol 1986, 7:1273-1278.
10. Lange A, Palka P, Donnelly J, et al.: Quantitation of mitral regurgitation orifice area by 3-dimensional echocardiography: comparison with effective regurgitant orifice area by PISA method and proximal regurgitant jet diameter. Intern J Cardiol 2002, 86:87-98.
11. Kwan J, Shiota T, Agler DA, et al.: Real-time three-dimensional echocardiography study. Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation 2003, 107:1135-1140. Real-time three-dimensional echocardiography was used to study geometric differences of the mitral apparatus in patients with mitral regurgitation caused by ischemic cardiomyopathy and idiopathic dilated cardiomyopathy. The pattern of mitral deformation from the medial to the lateral side was asymmetric, and was symmetric in dilated cardiomyopathy.
12. Koelling TM, Aaronson KD, Cody RJ, et al.: Prognostic significance of mitral regurgitation and tricuspid regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002, 144:524-529. In a study of 1421 patients with systolic dysfunction, increasing severity of mitral regurgitation was associated with poor outcome (relative risk, 1.84; range, 1. 43 to 2.38; for severe regurgitation) and reduced survival.
13. Aviernos JF, Gersh BJ, Melton LJ III, et al.: Natural history of asymptomatic mitral valve prolapse. Circulation 2002, 106:e9021-e9028. In a study of 833 patients in Olmstead County with newly diagnosed asymptomatic mitral valve prolapse, the most frequent primary risk factors for cardiovascular mortality were moderate to severe mitral regurgitation and decreased left ventricular ejection fraction. Mild mitral regurgitation was among secondary risks predictive of cardiovascular morbidity (others included left atrial size of 40 mm or more, flail leaflet, atrial fibrillation, and age 50 years or older). The secondary risk factors were more predictive of morbidity, but not mortality.
14. Grigioni F, Avierinos JF, Ling LH, et al.: Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol 2002, 40:84-92. The relationship of mitral regurgitation to atrial fibrillation was assessed in a study of 360 patients with regurgitation resulting from flail leaflets and 89 subjects with moderate to severe regurgitation resulting from mitral valve prolapse. The rate of development of atrial fibrillation was 5% per year and was simirar in subjects with regurgitation resulting from flail leaflet or prolapse. Increased cardiac mortarity and morbidity were observed with conservative management after the onset of atrial fibrillation.
15. Mills WR, Barber JE, Skiles JA, et al.: Clinical, echocardiographic, and biomechanical differences in mitral valve prolapse. Am J Cardiol 2002, 89:13944-13949.
16. Tolis GA Jr, Korkolis DP, Kopf GS, et al.: Revascularization alone (without mitral valve repair) suffices in patients with advance ischemic cardiomyopathy and mild-to-moderate mitral regurgitation. Ann Thoracic Surg 2002, 74:1476-1480.
17. Agricola E, Oppizzi M, Maisano F, et al.: Detection of mechanisms of immediate failure by transesophageal echocardiography in quadrangular resection mitral varve repair technique for severe mitral regurgitation. Am J Cardiol 2003, 91:175-179. This study evaluates intraoperative transesophageal echocardiography in 205 patients with prolapse or flail leaflet undergoing mitral repair by quadrangular resection. The most common causes of repair failure were malcoaptation in the posterior leaflet and residual prolapse of the anterior or posterior leaflets.
18. Freed LA, Benjamin EJ, Levy D, et al.: Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study. J Am Cell Cardiol 2002, 40:1298-1304. Findings from the Framingham Heart Study revealed that only 6.5% of patients with classic prorapse had severe mitral regurgitation.
19. Ling LH, Enriquez Sarano M, Seward JB: et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996, 335:1417-1423.
20. Faris R, Coats AJ, Henein MY: Echocardiography-derived variables predict outcome in patients with nonischemic dilated cardiomyopathy with or without a restrictive filling pattern. Am Heart J 2002, 144:343-350.