Predictors of Improvement of Unrepaired Moderate Ischemic Mitral Regurgitation in Patients Undergoing Elective Isolated Coronary Artery Bypass Graft Surgery
Предикторы улучшения нереконструированной умеренной ишемической митральной регургитации у пациентов, подвергающихся плановой изолированной операции аортокоронарного шунтирования
2009-09-29
SCID: 54.1/dhvpgdu2
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coronary artery bypass graft surgeryischemic heart diseasemoderate ischemic mitral regurgitationpapillary muscle dyssynchronyviable myocardium
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Abstract (AI)
BACKGROUND: The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery. METHODS AND RESULTS: The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001). CONCLUSIONS: Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.
Key Findings
1
Absence of papillary-muscle dyssynchrony below 60 ms independently predicted improvement, with an odds ratio of 1.49 (95% CI, 1.29–1.72).
2
Among patients with moderate ischemic mitral regurgitation undergoing isolated coronary artery bypass grafting, 57 improved and 64 failed to improve at 12 months.
3
Ninety-three percent of patients with both viable myocardium and absent dyssynchrony improved, whereas improvement occurred in only 34% with dyssynchrony and 18% with nonviable myocardium.
4
Preoperative viable myocardium and lower papillary-muscle dyssynchrony were significantly associated with postoperative improvement in mitral regurgitation.
5
Viable myocardium in at least five segments independently predicted improvement, with an odds ratio of 1.45 (95% CI, 1.22–1.89).
Research Object
Moderate ischemic mitral regurgitation in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery
Research Subject
Predictors and determinants of postoperative improvement or persistence of moderate ischemic mitral regurgitation, particularly viable myocardium extent and papillary-muscle dyssynchrony
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2009-09-29
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