Pathophysiology, Diagnosis, and New Therapeutic Approaches for Ischemic Mitral Regurgitation

Hadjadj, Sandra; Marsit, Ons; Paradis, Jean‐Michel; Beaudoin, Jonathan

doi:10.1016/j.cjca.2020.12.011

Cited by 7 publications

(6 citation statements)

References 63 publications

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“…Unlike primary mitral regurgitation, which is a disease of the mitral valve leaflets, functional ischemic mitral regurgitation is a consequence of adverse left ventricular (LV) remodeling after myocardial injury [2,13,14 ▪▪ ,15 ▪ ]. Chronic ischemic mitral regurgitation is a broad term encompassing Carpentier Type I and Type IIIb disease (Fig.…”

Section: Pathophysiology Of Ischemic Mitral Regurgitationmentioning

confidence: 99%

Ischemic mitral regurgitation: when should one intervene?

Rahmouni

Shahinian

Deng

et al. 2021

Current Opinion in Cardiology

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Purpose of reviewOptimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research. Recent findingsMechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitation, revascularization can lead to left ventricular reverse remodeling in some. In patients with severe ischemic mitral regurgitation, mitral valve replacement may be associated with fewer adverse events related to heart failure and cardiovascular readmissions, compared with valve repair, although reverse remodeling may be better in patients following successful mitral repair. Transcatheter edge-to-edge repair also further complements the treatment of ischemic mitral regurgitation. SummaryA tailored approach to patients should be considered for each patient presenting with ischemic mitral regurgitation.

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Section: Pathophysiology Of Ischemic Mitral Regurgitationmentioning

confidence: 99%

Ischemic mitral regurgitation: when should one intervene?

Rahmouni

Shahinian

Deng

et al. 2021

Current Opinion in Cardiology

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“…Appropriate diagnostic evaluation using three‐dimensional echocardiography and cardiac magnetic resonance imaging is valuable in clinical risk stratification and optimal treatment selection 6 …”

Section: Introductionmentioning

confidence: 99%

“…5 Appropriate diagnostic evaluation using three-dimensional echocardiography and cardiac magnetic resonance imaging is valuable in clinical risk stratification and optimal treatment selection. 6 Management of IMR is challenging and continues to evolve. It is largely based on medical therapy.…”

Section: Introductionmentioning

confidence: 99%

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Gamal

El-Fiky

Gamea

et al. 2022

Journal of Cardiac Surgery

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Background and Aim Ischemic mitral regurgitation (IMR) is a serious consequence of coronary artery disease. The choice of the optimal surgical strategy remains debatable. The aim of the present meta‐analysis is to compare the outcomes of mitral valve repair (RPR) versus replacement (RPL) regarding perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Methods Electronic searches were performed using the searchable databases of Google Scholar, Pubmed, and Embase, and the search terms mitral valve, IMR, RPR, RPL, and coronary artery bypass grafting. The main outcomes of interest are perioperative mortality, overall mortality, reoperation, recurrence of MR, and reverse remodeling after surgery. Perioperative mortality was defined as death during the surgery or within 30 days after the operation. Results There was a trend towards better perioperative survival in the RPR arm. However, the difference fell short of statistical significance [odds ratio (OR) (95% confidence interval [CI]): 0.66 (0.41–1.07), p = 0.09]. Patients submitted to RPR experienced a significantly higher MR recurrence rate when compared with their counterparts submitted to RPL [OR (95% CI): 16.8 (5.07–55.7, p = 0.00001)]. Conclusion There is a trend towards lower perioperative mortality in RPR in comparison to RPL. On the other hand, RPL was associated with significantly lower recurrence rates.

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“…Ischemic MR occurs as a consequence of adverse LV remodeling with papillary muscle displacement, leaflet tethering, reduced MV closing forces, annular dilation, and failure of leaflet coaptation 10) . Recently, another mechanism (thickened, shortened, and fibrotic leaflet) was reported to contribute to ischemic MR 11) .…”

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confidence: 99%

“…Notably, atrial functional MR, characterized by insufficient leaflet lengthening caused by an enlarged left atrium and annular enlargement with normal MV leaflet motion, differs from ischemic MR 12,13) . Doppler echocardiography obtained from transthoracic echocardiography incorporates several methods, such as color flow, continuous wave, and pulsed Doppler, in addition to assessing the hemodynamic consequences of MR in cardiac chambers 10) . However, the quantitative assessment of functional MR is difficult due to geometric assumptions and technical challenges 14) and can be inaccurate due to the eccentric nature of the jet and crescentic shape of the regurgitant orifice 15) .…”

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confidence: 99%

Ischemic Mitral Regurgitation

Izumi

Higuchi

Kitamura

et al. 2022

Journal of Coronary Artery Disease

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─ 24 ─ I. Introduction Mitral regurgitation (MR) is caused by anatomical or functional impairment of components of the mitral apparatus necessary for a normal valve function, including the left ventricle (LV), papillary muscle, chordae tendineae, leaflets, and annulus 1) . MR is the most common valve condition in the developed world, with a prevalence of 22% among patients > 65 years old.Its prevalence is projected to increase substantially over the next few decades as the population ages [2][3][4] . MR has been classifi ed as functional in 65% of cases and attributed to LV remodeling or dysfunction, with the remainder attributed to atrial fi brillation/ fl utter, or to idiopathic annular dilation. The severity of functional MR may vary dramatically as a function of LV loading conditions, heart rhythm, conduction system disease, and myocardial ischemia. Functional MR is associated with lower event-free rates (heart failure [HF] or death) than degenerative MR of a similar magnitude. However, whether functional MR is simply a marker of poor outcomes due to LV dysfunction or contributes independently to long-term outcomes in this patient population remains uncertain 5,6) .In the past decade, transcatheter edge-to-edge repair (TEER) using the MitraClip (Abbott Vascular,

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Pathophysiology, Diagnosis, and New Therapeutic Approaches for Ischemic Mitral Regurgitation

Cited by 7 publications

References 63 publications

Ischemic mitral regurgitation: when should one intervene?

Ischemic mitral regurgitation: when should one intervene?

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

Ischemic Mitral Regurgitation

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