The effect of the revascularization strategies on the severity of ischemic moderate mitral regurgitation

Abstract

Although it is known that revascularization is useful for the treatment of patients with ischemic mitral regurgitation (MR), the effects of revascularization on MR have not been well examined. In this study, we aimed to show the effect of revascularization strategies on patients with moderate ischemic MR, quantitatively and prospectively. Forty-seven patients with moderate MR (2 to 3 +) who were offered revascularization due to the diagnosis of coronary artery disease were enrolled in the study. Patients were divided into three groups according to their treatment strategies. Patients who underwent percutaneous coronary intervention (PCI) were defined as group 1 (n=18), patients who underwent surgical revascularization (CABG) as group 2 (n=17) and patients who received only medical treatment as group 3 (n=12). Transthoracic echocardiography (TTE) was performed for all patients at the beginning of the study, and after three months. MR grading was performed using semi-quantitative (I-IV) and quantitative (EOA, RV, and RF) methods. Initial MR grading parameters of the three groups were similar. When the initial and the third month MR parameters of patients were compared, there was a significant decrease in group 1 in effective orifice area (EOA) (p=0.002), regurgitant volume (RV) (p=0.005), regurgitant fraction (RF) (p=0.002) and semi-quantitative MR (p=0.002). There was also a significant decrease in group 2 in EOA (p=0.002), RV (p=0.001), RF (p=0.001) and semi-quantitative MR (p=0.005) grades after 3 months. However, mitral regurgitation severity was not changed with medical treatment in group 3. There was no difference between groups when residual MR grades at the third month were compared with each other (p>0.05). Our study showed that percutaneous or surgical revascularization strategies significantly improved MR parameters, on the other hand no improvement was obtained with medical treatment. In spite of the improvement in the severity of MR, there were still significant residual MR after revascularization strategies without valvular intervention. For this reason it can be suggested that revascularization strategies without valvular intervention is effective but not sufficient for the treatment of patients with ischemic MR.