Rashid SongurovBakoulev National Medical Research Center , Russian Federation
Title: Prediction of the dynamics of ischemic mitral regurgitation after myocardial revascularization
The aim of the study was to develop a diagnostic approach to assessing the nature of ischemic mitral regurgitation (reversible/irreversible), allowing to predict its dynamics after myocardial revascularization.
Material and methods. The study included 105 patients with coronary artery disease and ischemic mitral regurgitation (MR) who underwent examination and surgical treatment. Two groups of patients were formed depending on the dynamics of MR during the test with nitroglycerin (NTG): Group 1 (61 patients) - in which there was a significant decrease in the degree of MR during the test with NTG - patients with reversible ischemic MR; Group 2 (44 patients) - in whom there was no significant decrease in the degree of MR during the test with NTG - patients with irreversible nature of ischemic MR. The survey data were compared with the indicators obtained in the early and late postoperative period.
Results. A diagnostic approach that includes a nitroglycerin test in combination with echocardiography and tissue myocardial Doppler sonography makes it possible to predict the restoration of myocardial function and the possibility of reverse LV remodeling after revascularization, which underlies the reversibility of ischemic MR. The predictors of reversibility of ischemic MR are: a change in the vena contracta of regurgitation during a test with nitroglycerin more than -0.22 cm (?2=4.67, p=0.031); change in the ERO during a test with nitroglycerin more than -0.15 cm2 (?2=5.65, p=0.018); change in the volume of regurgitation during the test with nitroglycerin more than -20.0 ml (?2=3.15, p=0.07); change in LV EF during the test with NTG more than 4.5% (?2=3.97, p=0.047); change in the LV sphericity index by v/3 during a test with nitroglycerin more than -0.02 (?2=5.78, p=0.017); as well as indicators of the geometry of the mitral valve apparatus, reflecting the degree of its remodeling: the diameter of the fibrous ring of the MV is less than 35 mm (?2=17.0, p=0.001); the size of the left atrium is less than 40 mm (?2=6.98, ?=0.009); interpapillary distance less than 2.5 cm (?2=16.44, ?=0.001); tenting area less than 2.5 cm2 (?2=6.3, ?=0.013); coaptation distance less than 1.0 cm (?2=3.84, ?=0.06); the angle between the PPM and mitral valve annulus is less than 450 (?2=10.15, p=0.001); LV sphericity index per v/3 less than 0.3 (?2=4.03, ?=0.045).
Conclusion. The test with nitroglycerin in combination with echocardiography and tissue myocardial Doppler showed high information content in the diagnosis of ischemic MR reversibility.
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