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Clinical Trial
. 2014 May;55(3):592-8.
doi: 10.3349/ymj.2014.55.3.592. Epub 2014 Apr 1.

Response of functional mitral regurgitation during dobutamine infusion in relation to changes in left ventricular dyssynchrony and mitral valve geometry

Woong Gil Choi  1 , Soo Hyun Kim  1 , Soo Han Kim  2 , Sang Don Park  2 , Young Soo Baek  2 , Sung Hee Shin  2 , Sung Il Woo  2 , Dae Hyeok Kim  2 , Keum Soo Park  2 , Jun Kwan  2
Affiliations
Clinical Trial

Response of functional mitral regurgitation during dobutamine infusion in relation to changes in left ventricular dyssynchrony and mitral valve geometry

Woong Gil Choi et al. Yonsei Med J. 2014 May.

Abstract

Purpose: Functional mitral regurgitation (FMR) and myocardial dyssynchrony commonly occur in patients with dilated cardiomyopathy (DCM). The aim of this study was to elucidate changes in FMR in relation to those in left ventricular (LV) dyssynchrony as well as geometric parameters of the mitral valve (MV) in DCM patients during dobutamine infusion.

Materials and methods: Twenty-nine DCM patients (M:F=15:14; age: 62±15 yrs) with FMR underwent echocardiography at baseline and during peak dose (30 or 40 ug/min) of dobutamine infusion. Using 2D echocardiography, LV end-diastolic volume, end-systolic volume (LVESV), ejection fraction (EF), and effective regurgitant orifice area (ERO) were estimated. Dyssynchrony indices (DIs), defined as the standard deviation of time interval-to-peak myocardial systolic contraction of eight LV segments, were measured. Using the multi-planar reconstructive mode from commercially available 3D image analysis software, MV tenting area (MVTa) was measured. All geometrical measurements were corrected (c) by the height of each patient.

Results: During dobutamine infusion, EF (28±8% vs. 39±11%, p=0.001) improved along with significant decrease in cLVESV (80.1±35.2 mm³/m vs. 60.4±31.1 mm³/m, p=0.001); cMVTa (1.28±0.48 cm²/m vs. 0.79±0.33 cm²/m, p=0.001) was significantly reduced; and DI (1.31±0.51 vs. 1.58±0.68, p=0.025) showed significant increase. Despite significant deterioration of LV dyssynchrony during dobutamine infusion, ERO (0.16±0.09 cm² vs. 0.09±0.08 cm², p=0.001) significantly improved. On multivariate analysis, ΔcMVTa and ΔEF were found to be the strongest independent determinants of ΔERO (R²=0.443, p=0.001).

Conclusion: Rather than LV dyssynchrony, MV geometry determined by LV geometry and systolic pressure, which represents the MV closing force, may be the primary determinant of MR severity.

Keywords: Mitral regurgitation; dobutamine; dyssynchrony.

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Fig. 1
Fig. 1
Illustrations explaining geometric measurements of the mitral tethering angle (A), mitral valve tenting area (B), cross-sectional volumetric image at the mitral valve level (C), and CC plane (D) connecting both commissures. CC, commissure-commissure; Pα, posterior tethering angle; Aα, anterior tethering angle; AP, anteroposterior; MVTa, mitral valve tenting area; AML, anterior mitral leaflet; PML, posterior mitral leaflet; PC, posterior commissure; AC, anterior commissure.
Fig. 2
Fig. 2
Individual changes in effective regurgitant orifice, ejection fraction, mitral tenting area, dyssynchrony index between rest, and peak dobutamine infusion (red line: LBBB patients). LBBB, left bundle branch block.
See this image and copyright information in PMC

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