Functional mitral regurgitation in patients with aortic stenosis: prevalence, clinical correlates and pathophysiological determinants: a quantitative prospective study.
AIMS
In patients with aortic stenosis (AS) functional mitral regurgitation (FMR) is frequent and is attributed to left ventricular (LV) remodelling and to aortic gradient. However, the association of these variables with mitral effective regurgitant orifice (ERO) is still unknown.


METHODS AND RESULTS
We prospectively enrolled patients with aortic valve thickness and aortic velocities >2.5 m/s. We measured the LV diastolic (LVD) and systolic volumes (Simpson's method) and ejection fraction (EF) and longitudinal shortening (S-DTI), early, and late (A-DTI) lengthening velocities. The aortic valve area (AVA) and mean gradient (MG) were measured. FMR was considered in the absence of any alteration of mitral leaflet. ERO and regurgitant volume were measured by means of a proximal velocity surface area method method. One hundred and seventy-two patients formed the study population (mean age 76 ± 8 years; 50% female, EF 57 ± 14%, AVA 1.00 ± 0.4 cm(2)). Sixty-three per cent of patients had FMR (ERO range: 0.02 0.32 cm(2)). ERO was significantly associated with LVD (rho = 0.34; P = 0.0001), EF (r(s) = -0.35: P = 0.0001), and S-DTI (r = -0.57; P = 0.0001), A-DTI (rho = -0.47; P = 0.0001). In the subgroup of patients with a preserved EF (LVD <75 mL/m(2) and EF >55%), S-DTI, and A-DTI were the variables with the more powerful association with ERO (r(s) = -0.49 P = 0.0001 and r(s) = -0.40 P = 0.0001, respectively). In the overall population there was a non-significant negative association between the degree of AS and ERO (MG: r(s) = -0.08 P = 0.2 and AVA: r(s) = -0.08 P = 0.2).


CONCLUSION
In AS patients, the LV function is a main determinant of FMR even if EF is preserved. The association between ERO and valvular gradient is complex but tended to be negative.
['Rossi|Andrea|A|', 'Dandale|Rajesh|R|', 'Nistri|Stefano|S|', 'Faggiano|Pompilio|P|', 'Cicoira|Mariantonietta|M|', 'Benfari|Giovanni|G|', 'Onorati|Francesco|F|', 'Santini|Francesco|F|', 'Messika-Zeitoun|David|D|', 'Enriquez-Sarano|Maurice|M|', 'Vassanelli|Corrado|C|']
D000368:Aged D000369:Aged, 80 and over D000704:Analysis of Variance D001024:Aortic Valve Stenosis D015897:Comorbidity D015150:Echocardiography, Doppler D005069:Evaluation Studies as Topic D005260:Female D005500:Follow-Up Studies D006801:Humans D008297:Male D008944:Mitral Valve Insufficiency D015999:Multivariate Analysis D015995:Prevalence D011446:Prospective Studies D012720:Severity of Illness Index D013318:Stroke Volume D013997:Time Factors
functional mitral regurgitation aortic stenosis echocardiography left ventricular function