To access this material please log in or register

Register Authorize

Mitral regurgitation associated factors in women with ischemic heart disease without myocardial infarction

Kuznetsov V. A., Yaroslavskaya E. I., Krinochkin D. V., Pushkarev G. S., Marjinskikh L. V.

Keywords: women, CAD, mitral regurgitation

DOI: 10.18087/rhj.2013.6.1875

Background. Mitral regurgitation (MR) is known to be an independent predictor of cardiovascular death, which negatively influences prognosis in IHD patients. However the pathogenesis of MR in IHD patients without MI is understudied. Aim. Determining the factors related with chronic MR in women with IHD without MI. Materials and methods. Women with hemodynamically significant coronary stenosis (>75 % of lumen in at least one artery) without acute or past MI were selected among 16,839 patients included in the «Register of Performed Coronary Angiography Surgeries»: 183 female patients without MR and 20 female patients with moderate or severe MR. Results. Women with MR were older (61.2±8.9 years vs. 55.7±7.3 years, р=0.008); they more frequently had higher CHF NYHA FC (30 % vs. 17.1 %; р=0.033) and heart rhythm disorders (42.1 % vs. 12.3 %, р=0.001) with no significant difference in the prevalence of severe (III–IV FC) exertional angina. In women with MR, echoCG showed higher indices of left heart linear dimensions (left auricle, 23.5±3.0 mm / m² vs. 20.9±3.0 mm / m², р<0.001; LV, 27.1±2.8 vs. 25.1±2.5, р=0.006) and lower LV EF (56±4.6 vs. 60.2±4.6 %, р=0.001). Patients with MR less frequently had lesions in the anterior interventricular branch (59 % vs. 85 %, р=0.024). The multivariate analysis demonstrated that MR was independently related with heart rhythm disorders (OR=4.05; 95 % CI, 1.15–14.35, р=0.030), increased left atrial dimension index (OR=1.49; 95 % CI, 1.15–1.93, р=0.003), and lower LV EF (OR=0,86; 95 % CI, 0.76–0.96, р=0.008). Conclusion. In women with IHD without MI, MR is associated with heart rhythms disorders, increased left atrial dimension index, and reduced LV EF.
  1. Vahanian A, Baumgartner H, Bax J et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28 (2):230–268.
  2. Никитин Н. П., Алявин А. Л., Голоскокова В. Ю. и др. Особен­ности процесса позднего ремоделирования сердца у больных, перенесших инфаркт миокарда, и их прогностическое значение. Кардиология. 1999;39 (1):54–58.
  3. Lai T, Fallon JT, Liu J et al. Reversibility and pathohistological basis of left ventricular remodeling in hibernating myocardium. Cardiovasc Pathol. 2000:9 (6):323–335.
  4. Lima S, Ferreira A, Andrade MJ et al. Inferior and inferior-lateral location of left ventricular dyssynergy after myocardial infarction begets ischemic mitral regurgitation. Rev Port Cardiol. 2009;28 (11):1191–1200.
  5. Nielsen SL, Hansen SB, Nielsen KO et al. Imbalanced chordal force distribution causes acute ischemic mitral regurgitation: mechanistic insights from chordae tendineae force measurements in pigs. J Thorac Cardiovasc Surg. 2005;129 (3):525–231.
  6. Eltzschig HK, Shernan SK, Rosenberger P. Ischemic mitral regurgitation during temporary coronary-artery ligation. N Engl J Med. 2004;350 (23):2424–2425.
  7. Timek TA, Lai DT, Tibayan F et al. Ischemia in three left ventricular regions: Insights into the pathogenesis of acute ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2003;125 (3):559–569.
  8. Ohtsuka T, Hamada M, Kodama K et al. Marked attenuation of mitral regurgitation by stent implantation: a patient with unstable angina. J Cardiol. 1998;31 (Suppl 1):91–95.
  9. Ярославская Е. И., Кузнецов В. А., Пушкарев Г. С. и др. Факторы, ассоциированные с митральной регургитацией, у больных ишемической болезнью сердца без инфаркта миокарда. Кардиология. 2013;53 (1):28–32.
  10. Ярославская Е. И., Кузнецов В. А., Пушкарев Г. С. и др. Хрони­ческая ишемическая митральная регургитация и локализация коронарных стенозов у больных c постинфарктным кардиосклерозом. Кардиология. 2013;53 (2):55–60.
  11. Кузнецов В. А., Ярославская Е. И., Зырянов И. П. и др. Связь хронической ишемической митральной регургитации с локализацией коронарных стенозов у больных с постинфарктным кардиосклерозом. Международный журнал интервенционной кардиоангиологии. 2012;30:39–45.
  12. Ярославская Е. И., Кузнецов В. А., Пушкарев Г. С. и др. Хрони­ческая митральная регургитация у женщин с постинфарктным кардиосклерозом не связана с локализацией коронарных стенозов. Тезисы Российского национального конгресса кардиологов. 2012;487.
  13. Кузнецов В. А, Зырянов И. П., Колунин Г. В. и др. «Регистр проведенных операций коронарной ангиографии». Свидетельство о государственной регистрации базы данных № 2010620075, зарегистрировано в Реестре базы данных 1 февраля 2010 г.
  14. Galiuto L, Badano L, Fox K et al. The EAE textbook of echocardio­graphy. European Society of Cardiology. Oxford: Oxford University Publishing, 2011. –p.477.
  15. Pierard LA, Carabello BA. Ischaemic mitral regurgitation: pathophysiology, outcomes and the conundrum of treatment. Eur Heart J. 2010;31 (24):2996–3005.
  16. Borger MA, Alam A, Murphy PM et al. Chronic ischemic mitral regurgitation: repair, replace or rethink? Ann Thorac Surg 2006;81 (3):1153–1161.
  17. Gueret P, Khalife K, Jobic Y et al. Echocardiographic assessment of the incidence of mechanical complications during the early phase of myocardial infarction in the reperfusion era: a French multicentre prospective registry. Arch Cardiovasc Dis. 2008;101 (1):41–47.
Kuznetsov V.A., Yaroslavskaya E.I., Krinochkin D.V. et al. Mitral regurgitation associated factors in women with ischemic heart disease without myocardial infarction. Russian Heart Journal. 2013;12(6):360-364

To access this material please log in or register

Register Authorize
Ru En