Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging.

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Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: A pilot cardiovascular magnetic resonance imaging study Michael Flynn, MB, FRCSI (C/Th), Ronan Curtin, MD, Edward R. Nowicki, MD, MS, Jeevanantham Rajeswaran, MSc, Scott D. Flamm, MD, Eugene H. Blackstone, MD, Tomislav Mihaljevic, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 5, Pages 1063-1070.e2 (May 2009) DOI: 10.1016/j.jtcvs.2008.12.023 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Standard myocardial segments for assessing wall motion and scarring. Left, Short-axis depiction of segments; outer ring contains basilar segments; middle ring, mid-myocardial segments at papillary muscle level; inner ring, apical segments. Middle, Superimposed are territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), and left circumflex coronary artery (LCx). Right, Regions of the anterior and posterior papillary muscles. Ant. PM, Anterior papillary muscle; Post. PM, posterior papillary muscle. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Distribution of mean wall motion grades overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and regions of the anterior papillary muscle (Ant. PM) and posterior papillary muscle (Post. PM). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Distribution of mean scar scores overall and in territories of the left anterior descending coronary artery (LAD), right coronary artery (RCA), left circumflex coronary artery (LCx), and regions of the anterior papillary muscle (Ant. PM) and posterior papillary muscle (Post. PM). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Bubble plots depicting wall motion grade and scar score in representative segments of each coronary artery territory. A, Midanterior segment (17) of left anterior descending coronary artery territory. B, Midinferior segment (10) of right coronary artery territory (and a portion of region of posterior papillary muscle). C, Midinferolateral segment (11) of left circumflex coronary artery territory (and a portion of region of the posterior papillary muscle). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Correlation of mean wall motion grade and mean scar score overall and in coronary artery territories. LAD, Left anterior descending coronary artery; RCA, right coronary artery; LCx, left circumflex coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Temporal trend of postoperative mitral regurgitation (MR) grades across time. Solid lines are parametric estimates of percentages of patients in each MR grade after surgery, and symbols represent data grouped within unequal time intervals without regard to repeated assessment, to provide a crude verification of model fit. Solid lines are enclosed within 68% confidence limits obtained by bootstrap percentile method.21 The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Association of postoperative mitral regurgitation (MR) grade ≥2+ with scar score >25% versus ≤25% in region of posterior papillary muscle. Depiction is as in Figure 6. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Number of patients with echocardiograms available at various time points across the study and number of echocardiograms available for analysis. A, All patients. B, Patients with scar score ≤25% in posterior papillary muscle region. C, Patients with scar score >25% in posterior papillary muscle region. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Decomposition of temporal pattern of postoperative mitral regurgitation (MR) in the odds domain. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 1063-1070.e2DOI: (10.1016/j.jtcvs.2008.12.023) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions