Clinical value of RT-3DE in evaluating mitral valve configuration and the occurrence of VFMR in patients with ischemic cardiomyopathy: a clinical investigation

Purpose This study used real-time three-dimensional echocardiography (RT-3DE) to obtain three-dimensional (3D) geometric parameters of the mitral annulus and leaflets, including annular structural indices, leaflet angles, and tenting volume (VTent). We further compared the remodeling patterns between atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR). In addition, RT-3DE combined with speckle tracking imaging (STI) was applied to evaluate structural and functional changes of the left ventricular (LV) and mitral valve (MV) in patients with ischemic cardiomyopathy (ICM) and to identify factors associated with VFMR. Methods In this cross-sectional observational imaging study, 143 patients diagnosed with ICM admitted between July 2022 and November 2023 were enrolled and classified into a VFMR group (n = 68) and a non-VFMR group (n = 75). Another 53 patients with AFMR and 50 healthy controls were also recruited. MV geometry and LV strain parameters were measured via RT-3DE and STI. Multivariable logistic regression analysis was performed to identify the independent predictors of VFMR. Results Compared with healthy controls, patients with AFMR and VFMR had reduced left ventricular ejection fraction (LVEF), increased LV volumes, and enlarged left atrial diameter. Patients with VFMR presented higher levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Both functional mitral regurgitation (FMR) subtypes showed significant alterations in mitral annular and leaflet geometry, with VFMR demonstrating greater annular circularity and VTent. Impaired global longitudinal strain (GLS), reduced LV twist, and increased mitral VTent were identified as independent predictors of VFMR. The combined model incorporating these parameters yielded an area under the curve (AUC) of 0.814, indicating moderate predictive performance. Conclusion RT-3DE allows non-invasive evaluation of mitral annular and leaflet geometry and facilitates objective comparison of remodeling patterns between AFMR and VFMR. AFMR is characterized by a larger posterior leaflet angulation, whereas VFMR exhibits more pronounced annular circularity and leaflet tenting. In patients with ICM, impaired LV longitudinal strain, reduced LV twist, and increased VTent are independent factors associated with VFMR. Clinical trial number Not applicable.