ArticleEuropean heart journal. Cardiovascular Imaging2019
The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study.
Article in European heart journal. Cardiovascular Imaging, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed, 20 citations in OpenAlex.
- Paroxysmal hypotension and hypoxaemia caused by severe dynamic secondary mitral and tricuspid regurgitation after acute myocardial infarction.ESC heart failure · 2026Article
- Mitral Transcatheter Edge-to-Edge Repair in Acute Ischemic Mitral Regurgitation: Current Evidence and Future Perspectives.Reviews in cardiovascular medicine · 2025Review
- Importance of reassessment to identify trajectories of chronic transition of clinical indicators in post-myocardial infarction management.Cardiovascular intervention and therapeutics · 2024Review
- Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice.American heart journal plus : cardiology research and practice · 2023Review
- Acute Ischaemic Mitral Valve Regurgitation.Journal of clinical medicine · 2022Review
- Edge-to-edge therapy in acute mitral regurgitation. Proposal for a management protocol of the Ischemic Heart Disease and Acute Cardiac Care, Interventional Cardiology, and Cardiovascular Imaging Associations of the Spanish Society of Cardiology.REC, interventional cardiologyArticle
Corrections and comments
- Commented on by
- Erratum issued
Authors and funding
8 authors at 1 institution in 1 country.
Funding
Abstract
aimsMechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography. METHODS AND
resultsWe prospectively performed 3D echocardiography 2.3 ± 1.8 days after first MI, in 174 matched patients with (n = 87) and without IMR (n = 87). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n = 44). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29 ± 1.74 cm2 vs. 8.57 ± 1.94 cm2, P = 0.002, saddle shape 12.7 ± 4.5% vs. 15.0 ± 4.6%, P = 0.001), and larger tenting (length 6.36 ± 1.78 mm vs. 5.60 ± 1.55 mm, P = 0.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P < 0.01) and annular size, PM movement remained dynamic (all P < 0.01). Specific to acute IMR, without PM apical displacement (P > 0.70), greater separation (21.7 ± 4.9 mm vs. 20.0 ± 3.4 mm, P = 0.01), and widest angulation of PM (38.4 ± 6.2° for moderate vs. 33.5 ± 7.3° for mild vs. 31.4 ± 6.3° for no-IMR, P = 0.0009) wider vs. chronic MI (P < 0.01).
conclusions3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.
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