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. Author manuscript; available in PMC: 2023 Jul 1.
Published in final edited form as: JACC Cardiovasc Imaging. 2022 May 11;15(7):1212–1226. doi: 10.1016/j.jcmg.2022.03.014

Central Illustration. Myocardial Contractile Mechanics in Ischemic Mitral Regurgitation.

Central Illustration.

Multicenter stress CMR data from the SCMR registry demonstrated LV ischemia with contractile dysfunction in mitral valve adjacent (sub-papillary) territories to associate with FMR: Sub-papillary ischemia was associated with ≥moderate FMR independent of ischemia in remote regions. Associations between sub-papillary ischemia and FMR were weaker than for sub-papillary infarction, paralleled by greater dysfunction in infarcted segments – for both ischemia and infarction, only affected segments with contractile dysfunction conferred increased likelihood of FMR. Strain analysis in patients with and without ≥moderate FMR matched on ischemia distribution/extent demonstrated sub-papillary radial strain impairment to be associated with ≥moderate FMR and mitral apparatus remodeling independent of impaired strain in remote LV regions. Findings support a key role for ischemia-mediated contractile dysfunction in LV myocardium underlying the mitral valve in FMR.