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Tissue-based markers of right ventricular dysfunction in ischemic mitral regurgitation assessed via stress cardiac magnetic resonance and three-dimensional echocardiography

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Abstract

Ischemic mitral regurgitation (iMR) augments risk for right ventricular dysfunction (RVDYS). Right and left ventricular (LV) function are linked via common coronary perfusion, but data is lacking regarding impact of LV ischemia and infarct transmurality—as well as altered preload and afterload—on RV performance. In this prospective multimodality imaging study, stress CMR and 3-dimensional echo (3D-echo) were performed concomitantly in patients with iMR. CMR provided a reference for RVDYS (RVEF < 50%), as well as LV function/remodeling, ischemia and infarction. Echo was used to test multiple RV performance indices, including linear (TAPSE, S′), strain (GLS), and volumetric (3D-echo) approaches. 90 iMR patients were studied; 32% had RVDYS. RVDYS patients had greater iMR, lower LVEF, larger global ischemic burden and inferior infarct size (all p < 0.05). Regarding injury pattern, RVDYS was associated with LV inferior ischemia and infarction (both p < 0.05); 80% of affected patients had substantial viable myocardium (< 50% infarct thickness) in ischemic inferior segments. Regarding RV function, CMR RVEF similarly correlated with 3D-echo and GLS (r = 0.81–0.87): GLS yielded high overall performance for CMR-evidenced RVDYS (AUC: 0.94), nearly equivalent to that of 3D-echo (AUC: 0.95). In multivariable regression, GLS was independently associated with RV volumetric dilation on CMR (OR − 0.90 [CI − 1.19 to − 0.61], p < 0.001) and 3D echo (OR − 0.43 [CI − 0.84 to − 0.02], p = 0.04). Among patients with iMR, RVDYS is associated with potentially reversible processes, including LV inferior ischemic but predominantly viable myocardium and strongly impacted by volumetric loading conditions.

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Abbreviations

ASE:

American Society of Echocardiography

CAD:

Coronary artery disease

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

Echo:

Echocardiography

ESV:

End-systolic volume

EDV:

End-diastolic volume

EF:

Ejection fraction

GLS:

Global longitudinal strain

iMR:

Ischemic mitral regurgitation

LV:

Left ventricle

MI:

Myocardial infarction

MR:

Mitral regurgitation

NYHA:

New York Heart Association

PA:

Pulmonary artery

PH:

Pulmonary hypertension

ROC:

Receiver operating characteristics

RV:

Right ventricle

RVDYS :

Right ventricular dysfunction

S′:

Systolic excursion velocity

SPECT:

Single-photon emission computed tomography

TAPSE:

Tricuspid annular plane systolic excursion

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Acknowledgements

This study was supported by National Institutes of Health (Grant Nos. 1K23 HL140092-01 and 1R01HL128278-01).

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Authors and Affiliations

  1. Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street, New York, NY, 10021, USA

    Jiwon Kim, Javid Alakbarli, Brian Yum, Nathan H. Tehrani, Meridith P. Pollie, Christiane Abouzeid, Antonino Di Franco, Richard B. Devereux & Jonathan W. Weinsaft

  2. Division of Cardiology, Department of Surgery, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA

    Mark B. Ratcliffe

  3. Department of Bioengineering, University of California, San Francisco, Veterans Affairs Medical Center, San Francisco, CA, USA

    Mark B. Ratcliffe

  4. Lifespan Cardiovascular Institute, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Athena Poppas

  5. Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Robert A. Levine

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  1. Jiwon Kim
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  2. Javid Alakbarli
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Correspondence to Jiwon Kim.

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Kim, J., Alakbarli, J., Yum, B. et al. Tissue-based markers of right ventricular dysfunction in ischemic mitral regurgitation assessed via stress cardiac magnetic resonance and three-dimensional echocardiography. Int J Cardiovasc Imaging 35, 683–693 (2019). https://doi.org/10.1007/s10554-018-1500-4

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  • DOI: https://doi.org/10.1007/s10554-018-1500-4

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