Ischemic Mitral Regurgitation on the Threshold of a Solution

Levine, Robert A.; Schwammenthal, Ehud

doi:10.1161/circulationaha.104.486720

Cited by 435 publications

(301 citation statements)

References 163 publications

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“…7,11 Effect of anaesthetics and dobutamine on MR Secondary MR also varies dynamically with loading con ditions that modulate LV volume. 14 Regurgitant volume decreases substantially in response to unloading drugs, which is achieved through a reduction in EROA, but not through a change in the gradient across the mitral valve. Reduction of orifice area is likely to be related to a decrease in LV volume.…”

Section: Exercise-induced Changes In Mrmentioning

confidence: 98%

“…13 Acute MR commonly occurs as a secondary complication of acute left ventricular (LV) remodelling and dysfunction without structural valvular abnormalities, resulting from increased leaflet tethering and reduced mitral closing forces. 14 However, the severity of secondary MR varies widely, and even a mild form of MR in the acute setting of myocardial infarction is associated with poor progno sis. 15 Patients might also present with acute dyspnoea or flash pulmonary oedema.…”

Section: Factors That Influence Mrmentioning

confidence: 99%

“…Dobutamine reduces the severity of MR, mainly as a result of a reduction in EROA. However, dobutamine infusion can also induce severe and extensive ischaemia, which results in worsening of MR. 14 …”

Section: Exercise-induced Changes In Mrmentioning

confidence: 99%

“…Furthermore, correcting MR without changing LV geometry is not guaranteed to be bene ficial. 14 The ability to identify patients who have dynamic aggravation of MR, together with knowledge of the underlying mechanism, can influence revascularization strategies and concomitant mitral valve interventional procedures (Box 1).…”

Section: Management Of Dynamic Mrmentioning

confidence: 99%

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Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

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| Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).

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Section: Exercise-induced Changes In Mrmentioning

confidence: 98%

Section: Factors That Influence Mrmentioning

confidence: 99%

Section: Exercise-induced Changes In Mrmentioning

confidence: 99%

Section: Management Of Dynamic Mrmentioning

confidence: 99%

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Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

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“…In addition, pathologic states of the left ventricle (ie, ischemia, cardiomyopathy) can have deleterious effects on mitral valve function, causing mitral annular deformation, papillary muscle displacement, and LV remodeling, resulting in tethering of the mitral valve and lack of coaptation of the leaflets. 25,26 This can result in functional mitral regurgitation.…”

Section: Mitral Regurgitationmentioning

confidence: 99%

Evaluation of valvular disease by cardiac computed tomography assessment

Buttan

Yang

Budoff

et al. 2012

Journal of Cardiovascular Computed Tomography

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Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction

Aronson¹,

et al. 2006

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Background: The development of ischemic mitral regurgitation (MR) after myocardial infarction may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). However, few data are available on the relationship between ischemic MR and the long-term risk for HF. Methods: We prospectively studied 1190 patients admitted for acute myocardial infarction. Mitral regurgitation was assessed by echocardiography and was considered mild, moderate, and severe when the regurgitant jet area occupied less than 20%, 20% to 40%, and greater than 40% of the left atrial area, respectively. The median duration of follow-up was 24 months (range, 6-48 months). Results: Mild and moderate or severe ischemic MR was present in 39.7% and 6.3% of patients, respectively. After adjusting for ejection fraction and clinical variables (age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior infarction, ST-elevation infarction, and coronary revascularization), compared with patients without MR, the hazard ratios for HF were 2.8 (95% confidence interval [CI], 1.8-4.2; PϽ.001) and 3.6 (95% CI, 2.0-6.4; PϽ.001) in patients with mild and moderate or severe ischemic MR, respectively. The adjusted hazard ratios for death were 1.2 (95% CI, 0.8-1.8; P=.43) and 2.0 (95% CI, 1.2-3.4; P=.02) in patients with mild and moderate or severe MR, respectively. Conclusions: There is a graded independent association between the severity of ischemic MR and the development of HF after myocardial infarction. Even mild ischemic MR is associated with an increase in the risk of HF.

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Ischemic Mitral Regurgitation on the Threshold of a Solution

Cited by 435 publications

References 163 publications

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Therapeutic decision-making for patients with fluctuating mitral regurgitation

Evaluation of valvular disease by cardiac computed tomography assessment

Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction

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