Left ventricular strain in chronic ischemic mitral regurgitation in relation to mitral tethering pattern
Sandro Gelsomino1, Leen van Garsse, Fabiana Lucà
1Department of Heart and Vessels, Careggi Hospital, Florence, Italy. sandro.gelsomino@libero.it
Summary
Symmetric tethering in chronic ischemic mitral regurgitation is linked to widespread left ventricular (LV) strain abnormalities that surgery does not improve. Asymmetric patterns showed better outcomes post-mitral valve repair.
Area of Science:
- Cardiology
- Cardiac Surgery
- Biomedical Engineering
Background:
- Chronic ischemic mitral regurgitation (CIMR) affects left ventricular (LV) function.
- Mitral valve repair is a common treatment for CIMR.
- Tethering patterns of the mitral valve may influence surgical outcomes.
Purpose of the Study:
- To investigate if different tethering patterns in CIMR exhibit distinct LV strain distributions before and after mitral valve repair.
- To compare longitudinal, circumferential, and radial strain in symmetric versus asymmetric tethering patterns.
Main Methods:
- Retrospective analysis of 61 patients undergoing mitral valve repair for CIMR.
- Patients classified into symmetric (n=29) or asymmetric (n=32) tethering groups based on preoperative tethering angle ratio.
- Speckle-tracking imaging used to assess LV longitudinal, circumferential, and radial strain; 20 healthy subjects as controls.
Main Results:
- Symmetric tethering group (Group 1) showed impaired LV strain in all segments, particularly anterolateral, anterior, and inferolateral.
- Asymmetric tethering group (Group 2) had better strain in inferior and inferoseptal walls.
- Post-repair, Group 2 showed significant strain improvement; Group 1 experienced worsening strain in specific walls.
Conclusions:
- Symmetric tethering patterns in CIMR are associated with extensive LV strain abnormalities not reversed by surgery.
- Asymmetric tethering patterns may predict a better response to mitral valve repair regarding LV strain.
- Further large-scale studies are needed to confirm these findings.
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