Coronary Artery Disease
Outcomes of Patients With Ischemic Mitral Regurgitation Undergoing Percutaneous Coronary Intervention

https://doi.org/10.1016/j.amjcard.2014.07.012Get rights and content

Highlights

  • We examined ischemic mitral regurgitation (IMR) after percutaneous coronary intervention (PCI).

  • Mitral regurgitation (MR) improved in 1/3 of patients with only PCI.

  • IMR improvement was sustained in 75% of patients.

  • MR improvement was associated with reverse left ventricular remodeling.

  • Left atrial size is the most important predictor of IMR improvement.

Ischemic mitral regurgitation (IMR) is associated with poor outcomes in patients with coronary artery disease. The impact of percutaneous coronary intervention (PCI) on patients with IMR is not well elucidated. We sought to determine the outcomes of patients with severe IMR who underwent PCI. Patients with severe (≥3+) IMR who underwent PCI from 1998 to 2010 were identified. Improvement in IMR was defined as reduction in severity from ≥3+ to ≤2+ without any other invasive intervention beyond PCI. Outcomes were compared between patients with and without improvement in IMR after PCI. One hundred thirty-seven patients with severe IMR were included in our study. After PCI, 50 patients (36.5%) had improvement in IMR with PCI alone and 24 patients (18.5%) required another intervention. Left atrial size was a significant predictor of improvement in IMR (odds ratio 0.39, 95% confidence interval 0.2 to 0.8). Left ventricular size decreased (systolic diameter 3.9 ± 0.3 vs 4.6 ± 0.2 cm, p = 0.0008 and diastolic diameter 5.2 ± 0.2 vs 5.7 ± 0.2 cm, p = 0.002) and ejection fraction increased (39.1 ± 4.0% vs 33.1 ± 1.9%, p = 0.002) significantly after PCI in the patients with improvement in IMR compared with patients without improvement. Patients with improvement in IMR had numerically better survival; however, it was not statistically significant (p log-rank = 0.2). In conclusion, 1/3 of the patients with IMR had improvement in severity of IMR with PCI alone. Improvement in IMR was associated with left ventricular reverse remodeling. Left atrial size was an important predictor of improvement in IMR after PCI.

Section snippets

Material and Methods

All adults (>18 years) with severe (≥3+) IMR who underwent PCI at our institution from January 1, 1998, to January 1, 2010, were identified by querying our interventional cardiology databases. IMR was defined as functional MR in the presence of significant CAD. By definition, such patients had no evidence of structural or primary MV disease defined as rheumatic MV disease, myxomatous degeneration, endocarditis, MV prolapse, ruptured chordae, ruptured papillary muscles, or other structural MV

Results

All patients with severe IMR who underwent PCI from January 1, 1998, to January 1, 2010, at our institution were considered for inclusion. Those patients who did not have at least 1 echocardiogram before and after PCI at our institution were excluded. A total of 172 patients with severe IMR undergoing PCI and with available echocardiographic data were identified, of whom 35 were excluded because of MVRe, heart transplantation, or CRT-D implantation before PCI. Baseline clinical,

Discussion

Our study demonstrates that in patients with severe IMR and CAD, PCI alone improved IMR in approximately 1/3 of patients (36%), and in at least 3/4 of these patients, this improvement was sustained. Baseline LA size was the only predictor of improvement in severity of MR after PCI. There was evidence of LV reverse remodeling, and although the survival in patients with improvement in IMR was not statistically significant, it was numerically better.

MR in patients with CAD has been associated with

Disclosures

The authors have no conflicts of interest to disclose.

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Funding sources: None.

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