Global left ventricular remodeling, extent of inferior wall infarct, and mitral valve geometry are important predictors of mitral regurgitation severity than total infarct size in advanced ischemic cardiomyopathy
© Cavalcante et al.; licensee BioMed Central Ltd. 2014
Published: 16 January 2014
Mitral regurgitation (MR) is common in patients with ischemic cardiomyopathy (ICM) and independently associated with worse mortality. We sought to determine the impact of adverse LV remodeling, total myocardial infarct (MI) size, location and extent of regional MI, and mitral valve geometry on the severity of mitral regurgitation.
A total of 494 patients with LVEF ≤ 40% and ≥ 70% stenosis in ≥ 1 epicardial coronary artery and prior history of CABG or PCI were screened. Patients with transthoracic echocardiogram and CMR studies within 7 days were selected. Forty-two patients (9%) were excluded either due to prior mitral valve surgery, unavailable studies or organic mitral valve disease. Other 42 patients were excluded because of no mitral regurgitation noted on their study. Mitral regurgitation was assessed using semi-quantitative vena contracta method from a parasternal long axis zoomed view obtained of the mitral valve. LV volumes and EF were calculated from cine short axis CMR images. Mitral valve geometry was measured on end-systolic 2, 3, and 4 chamber cine views. LV scar was measured 10-15 minutes after gadolinium injection and using phase-sensitive inversion recovery sequence.
Global LV remodeling, regional inferior myocardial scarring, and mitral valve geometry are more important predictors of worsening MR than total infarct size in patients with advanced ischemic cardiomyopathy.
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