Dilated cardiomyopathy with mitral regurgitation: Decreased survival despite a low frequency of left ventricular thrombus

doi:10.1016/0002-8703(91)90523-K

American Heart Journal

Volume 122, Issue 3, Part 1, September 1991, Pages 763-771

https://doi.org/10.1016/0002-8703(91)90523-K Get rights and content

Abstract

Ninety-one patients with dilated cardiomyopathy were studied by two-dimensional, pulsed, and color Doppler echocardiography (1) to detect and quantify mitral regurgitation (MR), (2) to record apical flow velocities in systole and diastole, and (3) to detect the presence of left ventricular thrombi. MR was detected in 57% of the patients and thrombi were present in 40%, but the occurrence of both MR and thrombus was rare (8%). Apical flow velocity was significantly higher throughout the cardiac cycle in the group with MR (diastole 15 ± 7 vs 9 ± 7 cm/sec; systole 29 ± 12 vs 16 ± 13 cm/sec; p < 0.001 for both), accounting for the rarity of thrombi in this group. Follow-up data on 89% of the patients showed markedly decreased survival in the group with MR (22% vs 60% at 32 ± 6 months, p < 0.005), and this was evident even in patients with mild MR. Thus although MR is a noninvasively obtainable marker of a large subgroup of patients with dilated cardiomyopathy “protected” from left ventricular thrombus formation, it is a sensitive marker of decreased survival.

References (39)

JP Segal et al.
Idiopathic cardiomyopathy: clinical features, prognosis and therapy
Curr Probl Cardiol
(1978)
JS Gottdiener et al.
Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by two-dimensional echocardiography
Am J Cardiol
(1983)
V Fuster et al.
The natural history of idiopathic dilated cardiomyopathy
Am J Cardiol
(1981)
SS Maze et al.
Flow characteristics in the dilated left ventricle with thrombus: qualitative and quantitative Doppler analysis
J Am Coll Cardiol
(1989)
CA Visser et al.
Two-dimensional echocardiography in the diagnosis of left ventricular thrombus: a prospective study of 67 patients with anatomic validation
Chest
(1983)
RW Asinger et al.
Observation on detecting left ventricular thrombus with two-dimensional echocardiography: emphasis on avoidance of false positive diagnosis
Am J Cardiol
(1981)
SS Maze et al.
The contribution of color Doppler flow imaging to the assessment of a left ventricular thrombus
Am Heart J
(1988)
BJ Delemarre et al.
Prediction of apical thrombus formation in acute myocardial infarction based on left ventricular spatial flow pattern
J Am Coll Cardiol
(1990)
LW Stevenson et al.
Effects of afterload reduction (diuretics and vasodilators on left ventricular volume and mitral regurgitation in severe congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
Am J Cardiol
(1987)
SA Dickerman et al.
Mitral and tricuspid valve regurgitation in dilated cardiomyopathy
Am J Cardiol
(1989)

S Kaul et al.

Prevalence and mechanisms of mitral regurgitation in the absence of intrinsic abnormalities of the mitral leaflets

Am Heart J

(1989)

K Takenaka et al.

Pulsed Doppler echocardiographic study of left ventricular filling in dilated cardiomyopathy

Am J Cardiol

(1986)

MA Shaikh et al.

Effect of mitral regurgitation on diastolic filling with left ventricular hypertrophy

Am J Cardiol

(1988)

AS Maisel et al.

The murmur of papillary muscle dysfunction in acute myocardial infarction: clinical features and prognostic implications

Am Heart J

(1986)

DV Unverferth et al.

Factors influencing the one-year mortality of dilated cardiomyopathy

Am J Cardiol

(1984)

RH Strauss et al.

Predictability of mitral regurgitation detected by Doppler echocardiography in patients referred for cardiac transplantation

Am J Cardiol

(1987)

TL Kelly et al.

Prediction of outcome in late-stage cardiomyopathy

Am Heart J

(1990)

BI Jugdutt et al.

Prospective 2-D echo evaluation of left ventricular thrombus and embolism after acute myocardial infarction

J Am Coll Cardiol

(1989)

WH Abelmann et al.

The challenge of cardiomyopathy

J Am Coll Cardiol

(1989)

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^☆: Supported in part by the Women's League for Medical Research, Albert Einstein Medical Center.

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Dilated cardiomyopathy with mitral regurgitation: Decreased survival despite a low frequency of left ventricular thrombus☆

Abstract

Curr Probl Cardiol

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

Chest

Am J Cardiol

Am Heart J

J Am Coll Cardiol

Am J Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

J Am Coll Cardiol

J Am Coll Cardiol