Рrediction of the dynamics of ischemic mitral regurgitation after myocardial revascularization
Authors:
Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation
For correspondence: Sign in or register.
Type: Original articles
DOI:
For citation: Koksheneva I.V., Maloroeva A.I., Golubev E.P., Ibragimov R.M., Turakhonov T.K., Kaplenko L.I. Рrediction of the dynamics of ischemic mitral regurgitation after myocardial revascularization. Creative Cardiology. 2022; 16 (3): 326–339 (in Russ.). DOI: 10.24022/1997-3187-2022-16-3-326-339
Received / Accepted: 11.03.2022 / 21.07.2022
Keywords: ischemic mitral regurgitation ischemic remodeling of the left ventricle remodeling of the mitral valve apparatus myocardial revascularization reversibility/irreversibility of ischemic mitral regurgitation
Abstract
Objective. To develop a diagnostic approach to assessing the nature of ischemic mitral regurgitation (reversible/irreversible), allowing to predict its dynamics after myocardial revascularization.
Material and methods. The study included 105 patients with coronary artery disease and ischemic mitral regurgitation (MR) who underwent examination and surgical treatment. Two groups of patients were formed depending on the dynamics of MR during the test with nitroglycerin (NTG): Group 1 (61 patients) – in which there was a significant decrease in the degree of MR during the test with NTG – patients with reversible ischemic MR; Group 2 (44 patients) – in whom there was no significant decrease in the degree of MR during the test with NTG – patients with irreversible nature of ischemic MR. The survey data were compared with the indicators obtained in the early and late postoperative period.
Results. A diagnostic approach that includes a nitroglycerin test in combination with echocardiography and tissue myocardial Doppler sonography makes it possible to predict the restoration of myocardial function and the possibility of reverse LV remodeling after revascularization, which underlies the reversibility of ischemic MR. The predictors of reversibility of ischemic MR are: a change in the vena contracta of regurgitation during a test with nitroglycerin more than –0.22 cm (χ2= 4.67, p = 0.031); change in the ERO during a test with nitroglycerin more than –0.15 cm2 (χ2= 5.65, p = 0.018); change in the volume of regurgitation during the test with nitroglycerin more than –20.0 ml (χ2= 3.15, p = 0.07); change in LV EF during the test with NTG more than 4.5% (χ2= 3.97, p = 0.047); change in the LV sphericity index by v/3 during a test with nitroglycerin more than –0.02 (χ2= 5.78, p = 0.017); as well as indicators of the geometry of the mitral valve apparatus, reflecting the degree of its remodeling: the diameter of the fibrous ring of the MV is less than 35 mm (χ2= 17.0, p = 0.001); the size of the left atrium is less than 40 mm (χ2= 6.98, р = 0.009); interpapillary distance less than 2.5 cm (χ2= 16.44, р = 0.001); tenting area less than 2.5 cm2 (χ2= 6.3, р = 0.013); coaptation distance less than 1.0 cm (χ2= 3.84, р = 0.06); the angle between the PPM and mitral valve annulus is less than 45° (χ2= 10.15, p = 0.001); LV sphericity index per v/3 less than 0.3 (χ2= 4.03, р = 0.045).
Conclusion. The test with nitroglycerin in combination with echocardiography and tissue myocardial Doppler showed high information content in the diagnosis of ischemic MR reversibility.
References
- Levine R.A., Schwammenthal E. Ischemic mitral regurgitation on the threshold of a solution: from paradoxes to unifying concepts. Circulation. 2005; 2; 112 (5): 745–58. DOI: 10.1161/CIRCULATIONAHA.104.486720
- Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Tugeeva E.F., Golubev E.P., Matskeplishvili S.T. Ischemic mitral regigitation: mechanisms of development and progressing, topical issues of treatment. Moscow, 2015 (in Russ.).
- Beaudoin J., Dal-Bianco J.P., Aikawa E., Bischoff J., Guerrero J.L., Sullivan S. et al. Mitral leaflet changes following myocardial infarction: clinical evidence for maladaptive valvular remodeling. Circ. Cardiovasc. Imaging. 2017; 10 (11): 006512. DOI: 10.1161/CIRCIMAGING.117.006512
- Penicka M., Linkova H., Lang O., Fojt R., Kocka V., Vanderheyden M., Bartunev J. et al.Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation. 2009; 120: 1474–81. DOI: 10.1161/CIRCULATIONAHA.108.842104
- Flynn M., Curtin R., Nowicki E.R., Rajeswaran J., Flamm S.D., Blackstone E.H., Mihaljevic T. Regional wall motion abnormalities and scarring in severe functional ischemic mitral regurgitation: a pilot cardiovascular magnetic resonance imaging study. J. Thorac. Cardiovasc. Surg. 2009; 137 (5): 1063–70. DOI: 10.1016/j.jtcvs.2008.12.023 6. Michler R.E., Smith P.K., Parides M.K., Ailawadi G., Thourani V., Moskowitz A.J. et al. Two-year outcomes of surgical treatment of moderate ischemic mitral regurgitation. N. Engl. J. Med. 2016; 374: 1932–41. DOI: 10.1056/NEJMoa1602003
- Lancaster T.S., Kar J., Cupps B.P., Henn M.C., Kulshrestha K., Koerner D.J., Pasque M.K. Topographic mapping of left ventricular regional contractile injury in ischemic mitral regurgitation. J. Thorac. Cardiovasc. Surg. 2017; 154: 149–58. DOI: 10.1016/j.jtcvs.2016.11.055
- Yoshida S., Fukushima S., Miyagawa S., Nakamura T., Yoshikawa Y., Hata H. et al. Mitral valve structure in addition to myocardial viability determines the outcome of functional mitral regurgitation after coronary artery bypass grafting. Circ. J. 2017; 25; 81 (11): 1620–7. DOI: 10.1253/circj.CJ-16-1280
- Buziashvili Yu.I., Koksheneva I.V., Asymbekova E.U., Turakhonov T.K., Golubev E.P. Prediction of the reversible and irreversible nature of ischemic mitral regurgitation in patients with coronary heart disease after myocardial revascularization. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2019; 20 (2): 141–51 (in Russ.). DOI: 10.24022/1810-0694-2019-20-2-141-151