Abstract
The aim of the study was to conduct a comparative assessment of the geometric and functional parameters of the left
ventricle-mitral valve complex in ischemic heart disease (IHD) patients with the reversible and irreversible nature of
ischemic mitral regurgitation (MR).
Material and methods. The study included 74 patients with coronary artery disease and ischemic mitral regurgitation,
who underwent examination and surgical treatment. Patients with a different etiology of mitral insufficiency were
excluded. Depending on the reversibility of ischemic MR according to a sample with nitroglycerin and comparison
with the dynamics of MR after myocardial revascularization, two groups of patients were analyzed: group 1 (n=36)
with a reversible pattern of ischemic MR, which showed a decrease in MR to a mild degree a sample with nitroglycerin
and after myocardial revascularization; Group 2 (n=38) – with the irreversible nature of ischemic MR, in which
there was no significant decrease in the degree of MR when tested with nitroglycerin.
Results. In patients with irreversible ischemic MR, significant impairments in the geometry of the mitral valve apparatus
(increase in the size of the fibrous ring (FR), dilatation of the left atrium (LA), increase in the area of tenting,
depth of coaptation, interpapillary distance) are determined, whereas in patients with a reversible ischemic MR,
these indicators are moderately impaired or within norms. In patients with irreversible MR, a more significant dilatation
of the left ventricle (LV) cavity, a more significant increase in systolic indices of LV sphericity at all levels, a more
significant decrease in the contractile function of the LV in comparison with patients with a reversible pattern of
regurgitation, in which these indicators are moderately normal or within normal values.
Analysis of the longitudinal systolic deformity of the LV myocardium revealed a significant reduction in the Strain of
the LV lateral wall in the group of patients with irreversible ischemic MR. Strain was more significantly reduced in
the area of both papillary muscles of mitral valve in patients with irreversible MR, but the differences did not reach
statistical significance. Comparison of the longitudinal Strain Rate of the myocardium showed a more significant
decrease in the systolic Strain Rate in the area of both papillary muscles in patients with irreversible ischemic MR.
Identified echocardiographic predictors of irreversibility of ischemic MR, which are: indicators of the geometry of
the mitral valve apparatus (FR diameter more than 35 mm, linear size of the LA (transverse) more than 4.2 cm, interpapillary
distance of more than 2.5 cm, area of tenting more than 2.5 cm2, depth of coaptation is more than 1.0 cm),
left ventricular geometry parameters (LV EDV more than 150 ml, LV ESV more than 80 ml, systolic index of LV
sphericity on basal third more than 0.6, on middle third – more 0.5), tissue doppler indices (Strain of anterior papillary
muscle less than -3.0%, Strain Rate (s) of side wall LV less than -0.3 s-1, Strain Rate (s) of posterior wall LV less
than -0.3 s-1, Strain Rate (s) of posterior papillary muscle less than -0.5 s-1).
Conclusion. Analysis of the geometric and functional parameters of the left ventricular-mitral valve complex in
patients with ischemic MR has allowed us to develop diagnostic criteria for assessing the potential reversibility of
regurgitation after myocardial revascularization.
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About the authors
- Yuriy I. Buziashvili, Dr. Med. Sc., Professor, Academician of the Russian Academy of Sciences, Head of the Clinical Diagnostic Department;
-
Inna V. Koksheneva, Dr. Med. Sc., Senior Researcher; orcid.org/0000-0002-8797-9340
-
El’mira U. Asymbekova, Dr. Med. Sc., Leading Research; orcid.org/0000-0002-5422-2069
-
Timur K. Turakhonov, Postgraduate;
-
Evgeniy P. Golubev, Cand. Med. Sc., Researcher; orcid.org/0000-0001-5354-937X
