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The authors suggest that exercise stress echocardiography should be used alongside cardiac MRI to better assess ischemic mitral regurgitation, given its load-dependent nature.
We first would like to thank Tanimoto et al 1 for their study regarding cardiac magnetic resonance and ischemic mitral regurgitation (IMR). They sought to explore the relationship between papillary muscle infarction (detected by postgadolinium cardiac magnetic resonance) and IMR. IMR is still a subject of debate: Its qualification is challenging, and its treatment remains not much evaluated. We believe it would be interesting to argue in regard to Tanimoto et al's conclusions. Because IMR is known to be related to left ventricular remodeling and to loading conditions, it probably should be explored by exercise stress echocardiography. We all know that IMR severity, even its reality, might be extremely load dependent. Exercise stress echocardiography has been demonstrated for IMR diagnosis and prognostic evaluation. 2 During an exercise, changes in loading conditions might reveal any significant IMR. hus, according to the 2008 European guidelines on the management on valvular heart diseases, 5 it would have been extremely informative to assess the Tanimoto et al patients by exercise echo and cardiac magnetic resonance (with the papillary muscle characteristics, including their localization). We then still do not really know whether papillary muscle vascularization has any kind of impact on the genesis of the IMR.
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Leurent et al. (2011) studied this question.
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