Impact of Elective Percutaneous Coronary Intervention on Improvement of Ischemic Mitral Regurgitation

Sadeghian, Hakimeh; Mohseni-badalabadi, Reza; Arzhan, Sorya; Abdollahi, Fahimeh; Jalali, Arash; Sahebjam, Mohamad; Zourofian, Arezo; Hosseinsabet, Ali

Volume 26, Issue 4 (Jun 2018) JSSU 2018, 26(4): 286-293 | Back to browse issues page

Mendeley

Zotero

RefWorks

Sadeghian H, Mohseni-badalabadi R, Arzhan S, Abdollahi F, Jalali A, Sahebjam M, et al . Impact of Elective Percutaneous Coronary Intervention on Improvement of Ischemic Mitral Regurgitation. JSSU 2018; 26 (4) :286-293
URL: http://jssu.ssu.ac.ir/article-1-4158-en.html

Impact of Elective Percutaneous Coronary Intervention on Improvement of Ischemic Mitral Regurgitation

Hakimeh Sadeghian

, Reza Mohseni-badalabadi ^*

Abstract: (3508 Views)

Introdution: Ischemic mitral regurgitation (IMR) remains one of the most complex and unresolved aspects of ischemic heart disease that the impact of percutaneous coronary intervention (PCI) on improvement of intensity of ischemic mitral regurgitation is not well clarified. Patients with coronary artery diseases and ischemic mitral regurgitation have a worse prognosis than the patients with coronary artery disease (CAD) and those without ischemic mitral regurgitation. We sought to investigate the impact of complete revascularization by percutaneous coronary intervention PCI on improvement of IMR in patients with CAD and comparisons of echocardiography indices in patients with and without improvement of ischemic mitral regurgitation.
Methods: In this cross sectional retrospective study, echocardiographic reports in pre- percutaneous coronary intervention time and 12 months after PCI of patients with moderate (≥2+) ischemic mitral regurgitation who underwent complete revascularization by percutaneous coronary intervention from Farvardin 1391 to Esfand 1393 were included in the study. Then, echocardiographic data of the patients with improved ischemic mitral regurgitation compared with the patients with non-improved ischemic mitral regurgitation.
Results: Comparison of echocardiographic indices before and after percutaneous coronary intervention revealed that after percutaneous coronary intervention (P = 0.002) in 15 patients (16%), improvement in ischemic mitral regurgitation was occurred. Also, left ventricular ejection fraction (P = 0.010), left ventricular end- diastolic (P = 0.003) and end-systolic diameters (P < 0.001), wall motion score index (P = 0.003), left atrial area (P = 0.001) and systolic pulmonary artery pressure (P = 0.046) in pre- percutaneous coronary intervention echocardiography were different between improved and none-improved IMR group.
Conclusion: Although, percutaneous coronary intervention can lead to improvement of ischemic mitral regurgitation but most patients did not show improvement of ischemic mitral regurgitation after percutaneous coronary intervention. The structural abnormality of left ventricle and atrium were different between improved and none-improved IMR group

Keywords: Mitral regurgitation, Ischemia, Percutaneous coronary intervention

Full-Text [PDF 861 kb] (1050 Downloads)

Type of Study: Original article | Subject: Cardiovascular
Received: 2017/04/10 | Accepted: 2018/01/20 | Published: 2018/09/15

References

1. Bouma W, van der Horst IC, Wijdh-den Hamer IJ, Erasmus ME, Zijlstra F, Mariani MA, et al. Chronic ischaemic mitral regurgitation. Current treatment results and new mechanism-based surgical approaches. Eur J Cardiothorac Surg 2010; 37(1): 170-85.

2. Agricola E, Oppizzi M, Pisani M, Meris A, Maisano F, Margonato A. Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Eur J Echocardiogr 2008; 9(2): 207-21.

3. Yousefzai R, Bajaj N, Krishnaswamy A, Goel SS, Agarwal S, Aksoy O, et al. Outcomes of patients with ischemic mitral regurgitation undergoing percutaneous coronary intervention. Am J Cardiol 2014; 114(7): 1011-7.

4. Pastorius CA, Henry TD, Harris KM. Long-term outcomes of patients with mitral regurgitation undergoing percutaneous coronary intervention. The Am J Cardiol 2007; 100(8): 1218-23.

5. Borger MA, Alam A, Murphy PM, Doenst T, David TE. Chronic ischemic mitral regurgitation: repair, replace or rethink? Ann Thorac Surg 2006; 81(3): 1153-61.

6. Campwala SZ, Bansal RC, Wang N, Razzouk A, Pai RG. Factors affecting regression of mitral regurgitation following isolated coronary artery bypass surgery. Eur J Cardiothorac Surg 2005; 28(5): 783-7.

7. Buja P, Tarantini G, Del Bianco F, Razzolini R, Bilato C, Ramondo A, et al. Moderate-to-severe ischemic mitral regurgitation and multivessel coronary artery disease: Impact of different treatment on survival and rehospitalization. Int J Cardiol 2006; 111(1): 26-33.

8. Sorysz D, Dudek D, Legutko J, Bartus S, Dubiel JS. The influence of percutaneous coronary intervention on mitral apparatus function in unstable coronary heart disease. Kardiol Pol 2004;61 )2(: 34-40.

9. Meliga E, Fiorina C, Valgimigli M, Belli R, Gagnor A, Sheiban I, et al. Early angio-guided complete revascularization versus culprit vessel PCI followed by ischemia-guided staged PCI in STEMI patients with multivessel disease. J Interv Cardiol 2011; 24(6): 535-41.

10. Kalarus Z, Lenarczyk R, Kowalczyk J, Kowalski O, Gasior M, Was T, et al. Importance of complete revascularization in patients with acute myocardial infarction treated with percutaneous coronary intervention. Am Heart J 2007; 153(2): 304-12.

11. Zhao W, Bai J, Zhang F, Guo L, Gao W. Impact of completeness of revascularization by coronary intervention on exercise capacity early after acute ST-elevation myocardial infarction. J Cardiothorac Surg 2014; 9: 50.

12. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, et al. Recommendation for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16(7): 777-802.

13. Chua S, Hung J, Chung SY, Lin YC, Fu M, Wu CJ, et al. Primary percutaneous coronary intervention lowers the incidence of ischemic mitral regurgitation in patients with acute ST-elevated myocardial infarction. Circ J 2010;74(11): 2386-92.

14. Soylu K, Kocakavak C, Demircan S, Köprülü D, Yüksel S, Dursun I. et al. The effect of the revascularization strategies on the severity of ischemic moderate mitral regurgitation. East J Med 2013;18(1): 16-22.

15. Kang DH, Kim MJ, Kang SJ, Song JM, Song H, Hong MK, et al. Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation 2006; 114(1): I499-503.

16. Booher AM, Chetcuti SJ, Bach DS. The impact of percutaneous coronary intervention on ischemic mitral regurgitation. J Heart Valve Dis 2012; 21(5): 564-9.

17. MacHaalany J, Bertrand OF, O'Connor K, Abdelaal E, Voisine P, Larose E, et al. Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation. Cardiovasc Ultrasound 2014; 12: 14.

20.