Electrical Conduction Disturbance Effects on Dynamic Changes of Functional Mitral Regurgitation
Shota Fukuda, MD,
Richard Grimm, DO, FACC,
Jong-Min Song, MD,
Takashi Kihara, MD,
Masao Daimon, MD,
Deborah A. Agler, RDCS,
Bruce L. Wilkoff, MD, FACC,
Andrea Natale, MD,
James D. Thomas, MD, FACC and
Takahiro Shiota, MD, FACC*
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
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Figure 1 Schema explaining echocardiographic measurements of mitral annulus (arrow) and tenting area (oblique line) in apical four-chamber view. LA = left atrium; LV = left ventricle; RA = right atrium; RV = right ventricle.
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Figure 2 Example images of instantaneous proximal flow convergence region (arrows) during regurgitation period with color Doppler imaging (upper). Typical pattern of mitral regurgitation (MR) flow rate showing an increase to maximum size at early-systole, a decrease at mid-systole, and a re-increase at late-systole or isovolumetric relaxation period (lower).
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Figure 3 Summary of mitral annulus area (A), tenting area (B), and mitral regurgitation (MR) flow rate (C). Note decrease of these parameters during mid-systole, followed by an increase during late-systole. These parameters at early-systolic peak were larger than those at late-systolic peak.
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Figure 4 Regression plots showing correlation of QRS duration and the ratio of early-systolic and late-systolic peaks of mitral regurgitation (MR) flow.
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Figure 5 Examples of color Doppler images before and after cardiac resynchronization therapy (CRT). Before CRT, the proximal flow convergence region of early-systolic peak was much larger than that of late-systolic peak (A). After CRT, the opposite pattern was observed (B).
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