Assessment Of Mitral Valve Geometry In Ischemic Mitral Regurgitation By Real-Time Three-Dimensional Echocardiography Combined With Speckle Tracking Imaging

Objective:To investigate the changes of mitral valve geometry in patients with ischemic mitral regurgitation(IMR)in varying degrees by using real-time three-dimensional transthoracic echocardiography combined with speckle tracking imaging,analyze the correlation between parameters and IMR volume,and provide reference for clinical treatment.Methods:IMR patients(n=111)were chosen,and divided,according to IMR severity,into mild group(n=41),moderate group(n=37)and severe group(n=33).Meanwhile healthy controls(n=45)were chosen into control group.All groups were given examinations of routine echocardiography,real-time three-dimensional transthoracic echocardiography and speckle tracking imaging.The left ventricular remodeling parameters included left ventricular end-systolic volume(LVESV),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),the papillary muscle parameters included length between the abterolateral papillary muscle tips and the contralateral anterior mitral annular(APM-AMA),length between the posteromedial papillary muscle tips and the conralateral anterior mitral annular(PPM-AMA),inter distance papillary muscle(IPMD),anterior papillary muscle longitudinal strain(ALS),posterior papillary muscle longitudinal strain(PLS),delay time(DT),the three dimensional mitral valve geometric parameters included anterior-to-posterior diameter(DAP),anterior leaflet area(A Ant),posterior leaflet area(A Post),non-planarangle(NPA),anterolateral to posteromedial diameter(ALPM),three-dimensional annular area(A3D),annular circumference(AC),tenting height(HTent),tenting volume(VTent),the difference between the parameters of each group were compared and the correlation between parameters and IMR volume was analyzed.Results:LVEDV,LVESV,NPA and DT in the mild group were all larger than those in the control group,while ALS and PLS were smaller than those in the control group.LVEDV,LVESV,IPMD,PPM-AMA,DAP,ALPM,AC,A3 D,A Ant,A Post,HTent,VTent and DT in the moderate group and severe group were all larger than those in the control group and LVEF,ALS and PLS in the moderate group and severe group were all smaller than those in the control group,APM-AMA in the severe group were larger than those in the control group(P < 0.05).There was the highest correlation between VTent and EROA(r=0.64,P<0.05),and there was a higher correlation between IPMD and VTent(r=0.61,P<0.05).Conclusion:Real-time three-dimensional transthoracic echocardiography combined with speckle tracking imaging can comprehensively evaluate the mitral valve complex and provide reference for clinical treatment.With the increase of IMR regurgitation,papillary muscle contraction function was further weakened.Moderate and severe regurgitation mitral valve geometries have obvious changes,there is the highest correlation between VTent and EROA,and there is a higher correlation between IPMD and VTent.The results are helpful to the development of surgical strategies for IMR treatment.