Clinical Outcomes and Prognosis

1356845 - Sex and Morphologic Associations with Functional Mitral Regurgitation: Impact of Cardiomyopathy Phenotype

Friday, January 27, 2023

9:40 AM – 9:50 AM

Location: Silver Pearl 2

Presenting Author(s)

SY

Salva R. Yurista, MD, PhD

Staff Scientist
Cleveland Clinic
Cleveland, Ohio, United States

Co-Author(s)

DS

Donna Salam, MD

Research Fellow
Cleveland Clinic, United States
MT

Mustafa Turkmani, MD

Research fellow
Cleveland Clinic, United States
DA

Danah Al-Deiri, MD

Research Fellow
Cleveland Clinic, United States
TW

Tom Kai Ming Wang, MBChB MD

Cardiologist
Cleveland Clinic, United States
ZP

Zoran Popovic, MD, PhD

Cardiologist
Cleveland Clinic, Ohio, United States
BG

Brian Griffin, MD

Cardiologist
Cleveland Clinic, Ohio, United States
AK

Amar Krishnaswamy, MD

Cardiologist
Cleveland Clinic, Ohio, United States
SK

Samir Kapadia, MD

Cardiologist
Cleveland Clinic, Ohio, United States
Scott Flamm, MD, FSCMR

Radiologist
Cleveland Clinic
Shaker Heights, Ohio, United States
WT

Wilson Tang, MD

Cardiologist
Cleveland Clinic, United States
Christopher Nguyen, PhD, FACC, FSCMR

Director
Cleveland Clinic
Cleveland, Ohio, United States

Primary Author(s)

Debbie Kwon, MD

Staff Physician
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure(s):

Christopher Nguyen, PhD, FSCMR: No financial relationships to disclose

Debbie Kwon, MD: No financial relationships to disclose

Background:

Functional mitral regurgitation (FMR) is a common complication of left ventricular dysfunction. Previous observational studies showed independent association between FMR and adverse outcome. This study compared the clinical and cardiac magnetic resonance (CMR) predictors of FMR in patients with ischemic cardiomyopathy (ICM) versus non-ischemic cardiomyopathy (NICM).

Methods:

We retrospectively studied patients with ICM (n=791) and NICM (n=633) who underwent cardiac magnetic resonance imaging between April 2002 and December 2017. Clinical characteristics left atrial and ventricular volumes and function, late gadolinium enhancement and mitral valve geometry derived from CMR were evaluated with univariable and multivariable linear regression analysis to determine their predictive value of FMR.

Results: Patients with NICM were more likely to be female (40% vs. 25%, p< 0.001) and younger (53±16 vs. 62±11,p< 0.001). In ICM, multivariate analyses identified female sex (p< 0.001), lower body mass index (BMI, p=0.018), increased left atrial volume index (LAVi, p< 0.001), lower atrial ejection fraction (LAEF, p< 0.001), and increased mitral valve (MV) annulus index (p=0.029) were independently associated with FMR-fraction. However, LVEDVi was not associated with increasing FMR. In contrast NICM, increased LVEDVi, MV annulus index and apical displacement were found to be strong univariate predictors of FMR in our study. However, abnormal MV geometry did not emerge as an independent predictor of IMR progression on our multivariable analysis. Female sex (p=0.004), increased LVEDVi (p< 0.001), LAVi (LAVi, p< 0.001) and lower LAEF (p=0.036) were independently associated with FMR-fraction in NICM.

Conclusion:

LV dilation, but not mitral valve geometry, appears to be significantly associated with FMR in NICM. Conversely, mitral annular dilation, but not LV dilation is significantly associated with FMR in ICM. Female sex and LA size and function are independently associated with FMR in both ICM and NICM. This study highlights the role of CMR as a powerful prognostic tool to highlight differences in morphologic associations with FMR based on cardiomyopathy phenotype.