Citation: American Journal of Cardiology. 112(11):1812-8, 2013 Dec 1..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Golba K; Mokrzycki K; Drozdz J; Cherniavsky A; Wrobel K; Roberts BJ; Haddad H; Maurer G; Yii M; Asch FM; Handschumacher MD; Holly TA; Przybylski R; Kron I; Schaff H; Aston S; Horton J; Lee KL; Velazquez EJ; Grayburn PA; STICH TEE Substudy Investigators.UI/PMID: 24035166.Subject(s): Aged | Cardiomyopathies/et [Etiology] | *Cardiomyopathies/us [Ultrasonography] | Echocardiography, Three-Dimensional | Echocardiography, Transesophageal | Female | Humans | Male | Middle Aged | *Mitral Valve/us [Ultrasonography] | Mitral Valve Insufficiency/et [Etiology] | *Mitral Valve Insufficiency/us [Ultrasonography] | Multivariate Analysis | Myocardial Ischemia/co [Complications] | *Myocardial Ischemia/us [Ultrasonography] | Prospective Studies | Severity of Illness Index | Stroke VolumeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal Article | Research Support, N.I.H., ExtramuralOnline resources: Click here to access onlineDigital Object Identifier: http://dx.doi.org/10.1016/j.amjcard.2013.07.047 (Click here)Abbreviated citation: Am J Cardiol. 112(11):1812-8, 2013 Dec 1.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: The mechanisms underlying functional mitral regurgitation (MR) and the relation between mechanism and severity of MR have not been evaluated in a large, multicenter, randomized controlled trial. Transesophageal echocardiography (TEE) was performed in 215 patients at 17 centers in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Both 2-dimensional (n = 215) and 3-dimensional (n = 81) TEEs were used to assess multiple quantitative measurements of the mechanism and severity of MR. By 2-dimensional TEE, leaflet tenting area, anterior and posterior leaflet angles, mitral annulus diameter, left ventricular (LV) end-systolic volume index, LV ejection fraction (LVEF), and sphericity index (p <0.05 for all) were significantly different across MR grades. By 3-dimensional TEE, mitral annulus area, leaflet tenting area, LV end-systolic volume index, LVEF, and sphericity index (p <0.05 for all) were significantly different across MR grades. A multivariate analysis showed a trend for annulus area (p = 0.069) and LV end-systolic volume index (p = 0.071) to predict effective regurgitant orifice area and for annulus area (p = 0.018) and LV end-systolic volume index (p = 0.073) to predict vena contracta area. In the STICH trial, multiple quantitative parameters of the mechanism of functional MR are related to MR severity. The mechanism of functional MR in ischemic cardiomyopathy is heterogeneous, but no single variable stands out as a strong predictor of quantitative severity of MR. Copyright 2013 Elsevier Inc. All rights reserved.