2017

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2017/№2

Ischemic mitral regurgitation in patients with stable coronary artery disease: gender features

Sumin A. N., Korok E. V., Sergeeva T. Yu.
Federal State Budgetary Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Federal Agency for Scientific Organizations, Sosnovy Bulvar 6, Kemerovo 650002

Keywords: ischemic mitral regurgitation, gender peculiarities

DOI: 10.18087/rhj.2017.2.2303

Aim. To study gender-related features of ischemic mitral regurgitation (MR) in patients with stable ischemic heart disease (IHD). Materials and methods. The analysis included 314 patients with IHD who were examined and managed in the surgery clinic of the Research Institute for Complex Issues of Cardiovascular Diseases prior to the coronary bypass (CB) surgery. Based on the gen­der and the presence and severity of MR , all patients were divided into four groups: group 1, women without MR (n=47); group 2, women with grade 2 or higher MR (n=14); group 3, men without MR (n=224); and group 4, men with grade 2 or higher MR (n=29). Patients with grade 1 MR and structural alterations of cardiac valves were not included into the analysis. Results. According to data of echocardiography (EchoCG) values of LV, left atrial (LA) and aortic dimensions and volumes were the lowest in the group of women without MR and the highest in the group of men with grade 2 and higher MR (р<0.001). Furthermore, median left ventricular ejection fraction (LV EF) was notably greater (63 %) for women without MR than in other groups (р<0.001). Both pulmonary systolic pressure and incidence of LV chronic aneurism prevailed among patients with grade 2 or higher MR (р>0.05). According to results of coronary angiography one-vessel coronary artery (CA) disease was observed significantly more frequently among women with grade 2 or higher MR (57.1%) than in other groups (21.3%; 18.8%; 27.6%; р=0.007). At the same time, the incidence of two-vessel and three-vessel CA disease was similar in all groups (р>0.05). The groups were comparable in severity of CA disease (р>0.05). Multifactorial analysis showed that independent predictors associated with finding of grade 2 or higher MR for women included one-­vessel CA disease (р=0.036), presence of LV aneurism (р=0.027), and a high EuroSCORE risk (р=0.029); for men, these pre­dictors were clinical presentation of angina (р=0.031) and reduced LV EF (р<0.001). Conclusion. On evaluation of patients with stable IHD, moderate and more pronounced mitral valve dysfunction was observed in 23% of women and 11.5% of men (р=0.0327). Independent factors associated with the presence of moderate and pronounced MR were anginal symptoms and LV EF in men but not with the localization of coronary stenosis. In females, MR was associated with signs of LV aneurism, EuroSCORE risk indexes, and one-­vessel CA disease (although without association with a specific localization of stenosis). Results of this study should be taken into consideration in evaluation of MR origin in patients with stable IHD.
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Sumin A. N., Korok E. V., Sergeeva T. Yu. Ischemic mitral regurgitation in patients with stable coronary artery disease: gender features. Russian Heart Journal. 2017;16 (2):83–90

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