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Diastolic dysfunction and left atrial enlargement as contributing factors to functional mitral regurgitation in dilated cardiomyopathy: Data from the Acorn trial

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http://www.sciencedirect.com/science/article/pii/S0002870309000702

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Conclusions

For patients with DCM in the Acorn trial, MR severity was associated with LA volume and mitral annular area but not with LV volume. Mitral annular area and LA volume were closely related, even in patients without significant MR. These findings suggest that LA enlargement caused by advanced diastolic dysfunction may contribute to causing significant MR by augmenting mitral annular dilatation in DCM.

Ventricular remodeling and mitral valve modifications in dilated cardiomyopathy: New insights from anatomic study

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http://www.sciencedirect.com/science/article/pii/S002252230200329X

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Conclusion: Differently from what was thought, in ischemic or idiopathic dilated cardiomyopathy, dilation of mitral ring is proportional and does not exclusively affect the posterior portion. The degree of left ventricular dilation does not determine the degree of dilation of the mitral ring because they are independent processes

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Annular Geometry and Motion in Human Ischemic Mitral Regurgitation: Novel Assessment With Three-Dimensional Echocardiography and Computer Reconstruction

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http://www.sciencedirect.com/science/article/pii/S0003497504012457

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Patients with ischemic mitral regurgitation have annular dilatation, with an increase in anterior and posterior annular perimeters; this is accompanied by an increase in the intertrigonal distance and restriction of annular motion.

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Dilatações semelhantes produzem insuficiências desproporcionais. Como a patologia de base, isquemia ou miocardiopatia, afeta o anel mitral parece ser o mais importante.

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Estudos como modalidades diferentes mostram a mesma coisa:

É impossível analisar o refluxo mitral isoladamente pelo Doppler!