{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:03:28Z","timestamp":1793318608667,"version":"4.5.0"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2018,12,5]],"date-time":"2018-12-05T00:00:00Z","timestamp":1543968000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung and Blood Institute","doi-asserted-by":"crossref","award":["R01 HL120957"],"award-info":[{"award-number":["R01 HL120957"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Mechanisms of chronic ischaemic mitral regurgitation (IMR) are well-characterized by apically tethered leaflet caused by papillary muscles (PMs) displacement and adynamic mitral apparatus. We investigated the unique geometry and dynamics of the mitral apparatus in first acute myocardial infarction (MI) by using quantified 3D echocardiography.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We prospectively performed 3D echocardiography 2.3\u2009\u00b1\u20091.8\u2009days after first MI, in 174 matched patients with (n\u2009=\u200987) and without IMR (n\u2009=\u200987). 3D echocardiography of left ventricular (LV) volumes and of mitral apparatus dynamics throughout cardiac cycle was quantified. Similar mitral quantification was obtained at chronic post-MI stage (n\u2009=\u200944). Mechanistically, acute IMR was associated with larger and flatter annulus (area 9.29\u2009\u00b1\u20091.74 cm2 vs. 8.57\u2009\u00b1\u20091.94 cm2, P\u2009=\u20090.002, saddle shape 12.7\u2009\u00b1\u20094.5% vs. 15.0\u2009\u00b1\u20094.6%, P\u2009=\u20090.001), and larger tenting (length 6.36\u2009\u00b1\u20091.78\u2009mm vs. 5.60\u2009\u00b1\u20091.55\u2009mm, P\u2009=\u20090.003) but vs. chronic MI, mitral apparatus displayed smaller alterations (all P\u2009&lt;\u20090.01) and annular size, PM movement remained dynamic (all P\u2009&lt;\u20090.01). Specific to acute IMR, without PM apical displacement (P\u2009&gt;\u20090.70), greater separation (21.7\u2009\u00b1\u20094.9\u2009mm vs. 20.0\u2009\u00b1\u20093.4\u2009mm, P\u2009=\u20090.01), and widest angulation of PM (38.4\u2009\u00b1\u20096.2\u00b0 for moderate vs. 33.5\u2009\u00b1\u20097.3\u00b0 for mild vs. 31.4\u2009\u00b1\u20096.3\u00b0 for no-IMR, P\u2009=\u20090.0009) wider vs. chronic MI (P\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>3D echocardiography of patients with first MI provides insights into unique 4D dynamics of the mitral apparatus in acute IMR. Mitral apparatus remained dynamic in acute MI and distinct IMR mechanism in acute MI is not PM displacement seen in chronic IMR but separation and excess angulation of PM deforming the mitral valve, probably because of sudden-onset regional wall motion abnormality without apparent global LV remodelling. This specific mechanism should be considered in novel therapeutic strategies for IMR complicating acute MI.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjci\/jey177","type":"journal-article","created":{"date-parts":[[2018,10,31]],"date-time":"2018-10-31T20:14:43Z","timestamp":1541016883000},"page":"396-406","source":"Crossref","is-referenced-by-count":16,"title":["The unique mechanism of functional mitral regurgitation in acute myocardial infarction: a prospective dynamic 4D quantitative echocardiographic study"],"prefix":"10.1093","volume":"20","author":[{"given":"Toshiyuki","family":"Kimura","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"},{"name":"Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00e9ronique L","family":"Roger","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"},{"name":"Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nozomi","family":"Watanabe","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Barros-Gomes","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Topilsky","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"},{"name":"Department of Cardiovascular Diseases, Tel Aviv Medical Center, 6 Weizmann Street, Tel Aviv, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Nishino","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshisato","family":"Shibata","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Miyazaki Medical Association Hospital, Funado, Shinbeppu-chou, Miyazaki city, Miyazaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurice","family":"Enriquez-Sarano","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,12,4]]},"reference":[{"key":"2019072505400953500_jey177-B1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1161\/01.CIR.0000151097.30779.04","article-title":"Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation","volume":"111","author":"Bursi","year":"2005","journal-title":"Circulation"},{"key":"2019072505400953500_jey177-B2","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1161\/01.CIR.103.13.1759","article-title":"Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment","volume":"103","author":"Grigioni","year":"2001","journal-title":"Circulation"},{"key":"2019072505400953500_jey177-B3","doi-asserted-by":"crossref","first-page":"2451","DOI":"10.1093\/eurheartj\/ehs109","article-title":"Guidelines on the management of valvular heart disease (version 2012)","volume":"33","author":"Vahanian","year":"2012","journal-title":"Eur Heart J"},{"key":"2019072505400953500_jey177-B4","first-page":"e521","article-title":"2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"2019072505400953500_jey177-B5","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1161\/01.CIR.96.3.827","article-title":"Clinical significance of mitral regurgitation after acute myocardial infarction. 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