The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1063-1070.e2 , May 2009

Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study

  • Michael Flynn, MB, FRCSI (C/Th)

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Ronan Curtin, MD

      Affiliations

    • Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
    • Department of Radiology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Edward R. Nowicki, MD, MS

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Jeevanantham Rajeswaran, MSc

      Affiliations

    • Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Scott D. Flamm, MD

      Affiliations

    • Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
    • Department of Radiology, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Eugene H. Blackstone, MD

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
    • Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
    • ,
  • Tomislav Mihaljevic, MD

      Affiliations

    • Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
    • Corresponding Author InformationAddress for reprints: Tomislav Mihaljevic, MD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Avenue/Desk F24, Cleveland, OH 44195.

Received 8 May 2008 ,Revised 17 November 2008 ,Accepted 25 December 2008.

  • Image Result

    Standard myocardial segments for assessing wall motion and scarring. Left, Short-axis depiction of segments; outer ring contains basilar segments; middle ring, mid-myocardial segments at papillary mus

    Standard myocardial segments for assessing wall motion and scarring. Left, Short-axis depiction of segments; outer ring contains basilar segments; middle ring, mid-myocardial segments at papillary muscle level; inner ring, apical segments. Middle, Superimposed are territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), and left circumflex coronary artery (LCx). Right, Regions of the anterior and posterior papillary muscles. Ant. PM, Anterior papillary muscle; Post. PM, posterior papillary muscle.

  • Image Result
    Distribution of mean wall motion grades overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and region

    Distribution of mean wall motion grades overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and regions of the anterior papillary muscle (Ant. PM) and posterior papillary muscle (Post. PM).

  • Image Result
    Distribution of mean scar scores overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and regions of th

    Distribution of mean scar scores overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and regions of the anterior papillary muscle (Ant. PM) and posterior papillary muscle (Post. PM).

  • Image Result
    Bubble plots depicting wall motion grade and scar score in representative segments of each coronary artery territory. A, Midanterior segment (17) of left anterior descending coronary artery territory.

    Bubble plots depicting wall motion grade and scar score in representative segments of each coronary artery territory. A, Midanterior segment (17) of left anterior descending coronary artery territory. B, Midinferior segment (10) of right coronary artery territory (and a portion of region of posterior papillary muscle). C, Midinferolateral segment (11) of left circumflex coronary artery territory (and a portion of region of the posterior papillary muscle).

  • Image Result
    Correlation of mean wall motion grade and mean scar score overall and in coronary artery territories. LAD, Left anterior descending coronary artery; RCA, right coronary artery; LCx, left circumflex co

    Correlation of mean wall motion grade and mean scar score overall and in coronary artery territories. LAD, Left anterior descending coronary artery; RCA, right coronary artery; LCx, left circumflex coronary artery.

  • Image Result
    Temporal trend of postoperative mitral regurgitation (MR) grades across time. Solid lines are parametric estimates of percentages of patients in each MR grade after surgery, and symbols represent data

    Temporal trend of postoperative mitral regurgitation (MR) grades across time. Solid lines are parametric estimates of percentages of patients in each MR grade after surgery, and symbols represent data grouped within unequal time intervals without regard to repeated assessment, to provide a crude verification of model fit. Solid lines are enclosed within 68% confidence limits obtained by bootstrap percentile method.21

  • Image Result
    Association of postoperative mitral regurgitation (MR) grade ≥2+ with scar score >25% versus ≤25% in region of posterior papillary muscle. Depiction is as in Figure 6.

    Association of postoperative mitral regurgitation (MR) grade ≥2+ with scar score >25% versus ≤25% in region of posterior papillary muscle. Depiction is as in Figure 6.

  • Image Result
    Number of patients with echocardiograms available at various time points across the study and number of echocardiograms available for analysis. A, All patients. B, Patients with scar score ≤25% in pos

    Number of patients with echocardiograms available at various time points across the study and number of echocardiograms available for analysis. A, All patients. B, Patients with scar score ≤25% in posterior papillary muscle region. C, Patients with scar score >25% in posterior papillary muscle region.

  • Image Result
    Decomposition of temporal pattern of postoperative mitral regurgitation (MR) in the odds domain.

    Decomposition of temporal pattern of postoperative mitral regurgitation (MR) in the odds domain.

 Eugene H. Blackstone was supported in part by the Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research.

 This paper was presented at the 88th Annual Meeting of the American Association for Thoracic Surgery, San Diego, California, May 10–14, 2008.

PII: S0022-5223(09)00011-7

doi: 10.1016/j.jtcvs.2008.12.023

The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 5 , Pages 1063-1070.e2 , May 2009

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