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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.
Am Heart J. 2009 Apr; 157(4):762.e3-10.AH

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 > or =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.

Authors+Show Affiliations

Korea University College of Medicine, Seoul, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

19332207

Citation

Park, Seong-Mi, et al. "Diastolic Dysfunction and Left Atrial Enlargement as Contributing Factors to Functional Mitral Regurgitation in Dilated Cardiomyopathy: Data From the Acorn Trial." American Heart Journal, vol. 157, no. 4, 2009, pp. 762.e3-10.
Park SM, Park SW, Casaclang-Verzosa G, et al. Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: data from the Acorn trial. Am Heart J. 2009;157(4):762.e3-10.
Park, S. M., Park, S. W., Casaclang-Verzosa, G., Ommen, S. R., Pellikka, P. A., Miller, F. A., Sarano, M. E., Kubo, S. H., & Oh, J. K. (2009). Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: data from the Acorn trial. American Heart Journal, 157(4), e3-10. https://doi.org/10.1016/j.ahj.2008.12.018
Park SM, et al. Diastolic Dysfunction and Left Atrial Enlargement as Contributing Factors to Functional Mitral Regurgitation in Dilated Cardiomyopathy: Data From the Acorn Trial. Am Heart J. 2009;157(4):762.e3-10. PubMed PMID: 19332207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: data from the Acorn trial. AU - Park,Seong-Mi, AU - Park,Seung Woo, AU - Casaclang-Verzosa,Grace, AU - Ommen,Steve R, AU - Pellikka,Patricia A, AU - Miller,Fletcher A,Jr AU - Sarano,Maurice E, AU - Kubo,Spencer H, AU - Oh,Jae K, PY - 2008/07/18/received PY - 2008/12/18/accepted PY - 2009/4/1/entrez PY - 2009/4/1/pubmed PY - 2009/4/22/medline SP - 762.e3 EP - 10 JF - American heart journal JO - Am. Heart J. VL - 157 IS - 4 N2 - 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 > or =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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/19332207/Diastolic_dysfunction_and_left_atrial_enlargement_as_contributing_factors_to_functional_mitral_regurgitation_in_dilated_cardiomyopathy:_data_from_the_Acorn_trial_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00070-2 DB - PRIME DP - Unbound Medicine ER -