Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone

Purpose: Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral...

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Autores principales:	Radoslaw Piatkowski, Janusz Kochanowski, Monika Budnik, Michal Peller, Marcin Grabowski, Grzegorz Opolski
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	stress echo ischemic mitral regurgitation tenting area coaptation high Medicine R
Acceso en línea:	https://doaj.org/article/9e08657b2ba44332a28442492d590fc8
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spelling	oai:doaj.org-article:9e08657b2ba44332a28442492d590fc82021-11-11T17:29:36ZStress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone10.3390/jcm102148162077-0383https://doaj.org/article/9e08657b2ba44332a28442492d590fc82021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4816https://doaj.org/toc/2077-0383Purpose: Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone. Methods: A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; <i>n</i> = 90) or CABGmp (gr.2; <i>n</i> = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery. Results: Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm<sup>2</sup> provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; <i>p</i> = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; <i>p</i> = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; <i>p</i> = 0.742). Conclusions: The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.Radoslaw PiatkowskiJanusz KochanowskiMonika BudnikMichal PellerMarcin GrabowskiGrzegorz OpolskiMDPI AGarticlestress echoischemic mitral regurgitationtenting areacoaptation highMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4816, p 4816 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	stress echo ischemic mitral regurgitation tenting area coaptation high Medicine R
spellingShingle	stress echo ischemic mitral regurgitation tenting area coaptation high Medicine R Radoslaw Piatkowski Janusz Kochanowski Monika Budnik Michal Peller Marcin Grabowski Grzegorz Opolski Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
description	Purpose: Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone. Methods: A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; <i>n</i> = 90) or CABGmp (gr.2; <i>n</i> = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery. Results: Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm<sup>2</sup> provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; <i>p</i> = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; <i>p</i> = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; <i>p</i> = 0.742). Conclusions: The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.
format	article
author	Radoslaw Piatkowski Janusz Kochanowski Monika Budnik Michal Peller Marcin Grabowski Grzegorz Opolski
author_facet	Radoslaw Piatkowski Janusz Kochanowski Monika Budnik Michal Peller Marcin Grabowski Grzegorz Opolski
author_sort	Radoslaw Piatkowski
title	Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
title_short	Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
title_full	Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
title_fullStr	Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
title_full_unstemmed	Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone
title_sort	stress echocardiography protocol for deciding type of surgery in ischemic mitral regurgitation: predictors of mitral regurgitation recurrence following cabg alone
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/9e08657b2ba44332a28442492d590fc8
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Stress Echocardiography Protocol for Deciding Type of Surgery in Ischemic Mitral Regurgitation: Predictors of Mitral Regurgitation Recurrence following CABG Alone

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