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Mechanism of mitral regurgitation in the acute phase of inferior wall myocardial infarction: reduced closing force as a consequence of left ventricular systolic dysfunction in the presence of tethering as a determinant of mitral regurgitation

 Sung-Jin Hong  ;  Sung-Ai Kim  ;  Jin Hur  ;  Sang-Jae Rhee  ;  Chi Young Shim  ;  Jung-Sun Kim  ;  Young-Guk Ko  ;  Eui-Young Choi  ;  Donghoon Choi  ;  Yangsoo Jang  ;  Namsik Chung  ;  Jong-Won Ha 
 CIRCULATION JOURNAL, Vol.75(3) : 619-625, 2011 
Journal Title
Issue Date
Aged ; Echocardiography, Doppler ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve/physiopathology* ; Mitral Valve Insufficiency/physiopathology* ; Myocardial Infarction/pathology ; Myocardial Infarction/physiopathology* ; Regression Analysis ; Retrospective Studies ; Severity of Illness Index ; Stroke Volume ; Systole/physiology* ; Ventricular Dysfunction, Left/diagnostic imaging ; Ventricular Dysfunction, Left/physiopathology*
Mitral valve ; Myocardial infarction ; Regurgitation
BACKGROUND: To delineate the mechanism of mitral regurgitation (MR) in the acute phase of inferior wall myocardial infarction (MI). METHODS AND RESULTS: In 97 patients (age 59 ± 12 years) with acute inferior wall MI, the severity of MR, left ventricular (LV) geometric changes and function within 1.7 ± 1.3 days after MI by echocardiography was retrospectively evaluated. Infarct size was measured within 3.9 ± 1.7 days by cardiac magnetic resonance. Mild MR was present in 16 (16.5%) and moderate MR in 12 (12.4%) of 97 patients. There were no significant differences in mitral annular area, sphericity and distances between papillary muscle tips and the contralateral mitral annulus. However, patients with moderate MR had significantly larger LV end-systolic volume, tenting area and infarct size. There was a graded relationship between the severity of MR and LV ejection fraction. In a multivariable regression analysis, LV ejection fraction and tenting area were found to be independent predictors of the severity of MR (r(2)=0.180, P=0.001). CONCLUSIONS: MR was associated with LV systolic dysfunction, increase in end-systolic LV volume and tethering of mitral leaflet, suggesting reduced closing force as a consequence of LV systolic dysfunction in the presence of leaflet tethering would play a more pivotal role in the development of MR.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Sung Ai(김성애)
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Lee, Sang Jae(이상재)
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Chung, Nam Sik(정남식)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
Hur, Jin(허진) ORCID logo https://orcid.org/0000-0002-8651-6571
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
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