Predictors and Prognostic Impact of Progressive Ischemic Mitral Regurgitation in Patients With Advanced Ischemic Cardiomyopathy

Abstract

This was an observational cohort study of 336 consecutive patients with the diagnosis of ICM (≥70% stenosis in ≥1 epicardial coronary Background-Ischemic mitral regurgitation (IMR) is associated with poor outcomes. It is unknown what factors contribute to progression of IMR and how progressive IMR affects outcomes. We sought to determine imaging predictors of IMR progression and to determine if progressive IMR is an independent predictor of survival in patients with advanced ischemic cardiomyopathy. Methods and Results-Consecutive advanced ischemic cardiomyopathy patients who underwent cardiac magnetic resonance and echocardiograms at baseline with echocardiographic follow-up were studied. Cardiac magnetic resonance was used to assess left ventricular volumes, infarct size, and mitral valve geometry. The effective regurgitant orifice area (EROA) was calculated from the proximal isovelocity surface area by echocardiography. Repeated measures mixed effects and Cox proportional hazards regression models were built to identify predictors of IMR progression and survival. We evaluated 336 patients (age, 62±11 years) over a median follow-up time of 54 months: 154 patients were subsequently revascularized, and 182 patients were medically treated. Ninety-eight patients (29%) demonstrated an increase in EROA values of ≥0.1 cm 2 . There were 87 adverse events (death or transplant). On multivariable analysis, infarct size (P<0.001), progression in IMR (P=0.008), age (P=0.003), and baseline EROA (P=0.010) were independently associated with adverse events. Independent predictors of IMR progression were as follows: baseline EROA (P<0.001), left ventricular end-systolic volume index (P=0.014), and total scar (P=0.036). Conclusions-IMR frequently increases in severity, and progression is independently associated with adverse left ventricular remodeling and infarct size, as assessed by cardiac magnetic resonance. Furthermore, IMR progression is a powerful independent predictor of adverse events, even after controlling for the severity of IMR at baseline. (Circ Cardiovasc Imaging. 2016;9:e004577.

Automated Cardiac Valve Tracking for Flow Quantification with Four-dimensional Flow MRI

“…Four patient groups with valve regurgitation were studied: those with ischemic cardiomyopathy, those with corrected tetralogy of Fallot, those with corrected coarctation of the aorta, and those with corrected AVSD. In patients with ischemic cardiomyopathy, accurate regurgitation quantification, especially of the mitral valve, is important for patient treatment (surgery vs conservative management) (3) and progressing mitral valve regurgitation is recognized as an independent predictor of adverse events (1). In patients with corrected tetralogy of Fallot, pulmonary valve regurgitation is a common complication that can eventually lead to right ventricular dilatation and dysfunction, arrhythmias, and sudden cardiac death (19,20).…”

Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging

“…In patients with ischaemic cardiomyopathy and severe MR, the presence of severe scarring in the region of the posterior papillary muscle, as detected by preoperative CMR, can render these patients unsuitable for mitral annuloplasty 20 . Moreover, the extent of myocardial scarring is also informative about the progression of ischaemic MR 21 .…”

Known–Unknowns in Geriatric Cardiology

“…Data regarding the elderly subjects are limited, although it is proven that the coexistence of AS and CAD leads to a worse prognosis compared to that for an AS of comparable severity occurring alone [54,66]. Moreover, significant MR is observed in one-fifth of the octogenarians with non-ST elevation myocardial infarction, with poor prognosis [67,68].…”