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left ventricle is frequently the underlying pathophysiological mechanism of mitral malcoaptation, assessment of extent of myocardial fibrosis/scar has important prognostic implications (Fig. 8). Cavalcante et al.[28] showed in a cohort of 578 patients with ischemic cardiomyopathy and a mean mitral regurgitant fraction of 18% that patients with significant mitral regurgitation (defined by a regurgitant fraction ≥35%), that the presence of a myocardial scar size at least 30% of the left ventricular was associated with a hazard ratio of 5.41 for the combined endpoint of all-cause mortality or heart transplant.
Figure 8: Late gadolinium contrast-enhanced cardiovascular magnetic resonance in patient with ischemic mitral regurgitation. Panel a shows the apical four-chamber view with severe mitral regurgitation based on color flow Doppler data. On late gadolinium contrast-enhanced cardiovascular magnetic resonance, the presence of myocardial scar extent can be assessed (arrows).
Conclusion
The growing prevalence of patients with severe mitral regurgitation and a high surgical risk or contraindications for surgery has opened the field for transcatheter therapies, which are evolving rapidly. Preprocedural imaging with three-dimensional imaging techniques, such as transesophageal echocardiography, computed tomography, and cardiac magnetic resonance, provide the anatomic and functional information needed to determine the underlying mechanism and severity of mitral regurgitation
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