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| Cardiovascular Magnetic Resonance Assessment of Myocardial Scarring Predicts Recurrence of Functional Ischemic Mitral Regurgitation after Anuloplasty |
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Tomislav Mihaljevic, Michael Flynn, Ronan Curtin, Edward R. Nowicki, Jeevanantham Rajeswaran, Scott D. Flamm, Eugene H. Blackstone; Cleveland Clinic, Cleveland, OH Objective: The aims of this pilot study were to investigate the relation of cardiovascular magnetic resonance (CMR)-derived segmental wall motion and myocardial scarring to recurrence of mitral regurgitation (MR) following CABG and anuloplasty for ischemic MR. Methods: From January 2001 to November 2006, 29 patients with ≥3+ ischemic MR had preoperative CMR prior to CABG and anuloplasty. Wall motion abnormality was graded for 17 standard myocardial segments (0=none, 1+=hypokinesis, 2+=severe hypokinesis, 3+=akinesis, 4+=dyskinesis). Within each of these segments, degree of hyperenhancement, interpreted as scar, was graded as 0=0%, 1=1-25%, 2=26-50%, 3=51-75%, 4=76-100%. Postoperative recurrence of MR was assessed by 71 transthoracic echocardiograms and graded 0-4+. Results: Left ventricular ejection fraction ranged from 10-45% (mean 22±8.4%). Wall motion abnormalities grade ≥2+ were present in the majority of myocardial segments (median 13 of 17 segments). Scar >25% was present in a median of 3 segments, but in 44% of those in the territory of the posteromedial papillary muscle. Nearly all segments (95%) with >25% scar had ≥2+ wall motion abnormality. Although 90% of patients had no MR at hospital discharge, by 6 months, 30% had recurrent MR ≥2+. There was little association between wall motion abnormality and recurrence of MR (P>.1). However, in the territory of the posteromedial papillary muscle, 70% of patients with scar >25% had recurrent MR of ≥2+ by 6 months, compared with 15% of those with score ≤25% (P=.05; Figure.). Conclusion: This pilot study suggests that CMR assessment of scar burden more accurately predicts recurrent MR following CABG and anuloplasty for ischemic MR than do wall motion abnormalities. Routine preoperative CMR-derived scar burden may identify patients for whom alternative modes of treatment of ischemic MR should be considered.  Back to 88th Annual Meeting Back to Program Outline |
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