Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Mitral regurgitation depending on the degree of lesions to the coronary arteries in acute coronary syndrome

Authors: Bockeria L.A., Dzeytova A.Kh.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-1-53-5

UDC: 616.132.2

Link: Clinical Physiology of Blood Circulaiton. 2021; 1 (18): 53-59

Quote as: Bockeria L.A., Dzeytova A.Kh. Mitral regurgitation depending on the degree of lesions to the coronary arteries in acute coronary syndrome. Clinical Physiology of Circulation. 2021; 18 (1): 53–9 (in Russ.). DOI: 10.24022/1814-6910-2021-18-1-53-59

Received / Accepted:  29.01.2021 / 07.02.2021

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Abstract

Objective: To analyze the features of mitral regurgitation in patients with acute coronary syndrome depending on the degree of coronary artery lesions.

Material and methods. The research involved 61 patients which were brought to the emergency department of the Republican hospital of Ingushetia with a diagnosis of acute coronary syndrome. The average age of patients is 58 years. The study conducted a comparative analysis of mitral regurgitation in single-vessel and multi-vessel coronary artery lesions. Data on the quantitative assessment of mitral regurgitation in multi-vascular lesions with calculations on the SYNTAX Score scale are presented. The study was conducted on the GE Logic P5 device. The main indicator for the comparative assessment of mitral valve insufficiency was the regurgitation fraction, which was calculated using the PISA (proximal isovelocity surface area) method – the study of the proximal regurgitation zone. To quantify the degree of coronary artery damage, the SYNTAX Score scale was used. Data was analyzed using the statistical computing environment R 3.6.3 (R Foundation for Statistical Computing, Vienna, Austria).

Results. In patients with a single-vessel lesion, the anterior coronary artery is more often involved, which is most likely due to a violation of the blood supply to the papillary muscles or myocardial asynchrony. In patients with damage to the anterior interventricular branch, mitral regurgitation develops less frequently, which is associated with compensatory blood supply capabilities. When comparing patients with single-vessel and multi-vessel lesions, the following results were found: in patients with multi-vessel lesions, the degree of regurgitation is greater than in single-vessel lesions. A direct correlation is observed when comparing the results of echocardiography fad the results of evaluation of coronary artery damage on the SYNTAX Score scale.

Conclusion. Direct correlation between the degree of mitral regurgitation in acute coronary syndrome in patients with multi-vessel disease and SYNTAX Score scale may have a prognostic role in optimizing patient management.

References

  1. Альмухамбетова Р.К., Шуженова Б.О., Елшибаева А.Д., Мажибаева А.П., Джигитекова Б.Н., Сапаркызы К.Т. Функциональная митральная регургитация как фактор риска при ИБС. В кн.: Актуальные проблемы современной науки. Киев; 2016: 45–7.
  2. Абдуллаев А.А., Ибрагимова И.Б., Исламова У.А., Гафурова Р.М., Байтемирова Н.Н. Торасемид в профилактике прогрессирования митральной регургитации и хронической сердечной недостаточности в постинфарктном периоде. Российский кардиологический журнал. 2018; 5: 97–102. DOI: 10.15829/1560- 4071-2018-5-97-102
  3. Бокерия Л.А., Суханов С.Г., Орехова Е.Н. (ред.) Ишемическая недостаточность атриовентрикулярных клапанов. М.: НЦССХ им. А.Н. Бакулева РАМН; 2011: 5–19.
  4. Бузиашвили Ю.И., Кокшенева И.В., Хуцураули Е.М., Арутюнова Я.Э., Махмудов Ш.Г. Особенности ремоделирования левого желудочка и аппарата митрального клапана у больных ишемической болезнью сердца с прогрессированием митральной регургитации после хирургического лечения. Кардиоваскулярная терапия и профилактика. 2013; 2: 30–40. DOI: 10.15829/1728-8800-2013-2-30-40
  5. Timek T.A., Lai D.T., Tibayan F. Ischemia in three left ventricular regions: Insights into the pathogenesis of acute ischemic mitral regurgitation. J. Thorac. Cardiovasc. Surg. 2003; 125; 559–69. DOI: 10.1067/mtc.2003.43 6. Yosefy C., Beeri R., Guerrero J.L. Mitral regurgitation after anteroapical myocardial infarction: new mechanistic insights. Circulation. 2011; 123: 1529–36. DOI: 10.1161/CIRCULATIONAHA.110.977843
  6. Ярославская Е.И., Кузнецов В.А., Пушкарев Г.С., Криночкин Д.В., Зырянов И.П., Колунин Г.В. Митральная регургитация и локализация коронарных стенозов у больных с постинфарктным кардиосклерозом. Кардиология. 2013; 53 (2): 55–60.
  7. Sharma S.K., Seckler J., Israel D.H. Clinical, angiographic and anatomic findings in acute severe ischemic mitral regurgitation. Am. J. Cardiol. 1992; 70: 277.
  8. Борисов И.А., Диева Т.В., Чернигов Н.А., Уйманова М.Ю. Возможности стресс-эхокардиографии с добутамином в диагностике ишемической митральной дисфункции. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2008; 9 (3): 162.
  9. Messas E., Guerrero J.L., Handschumacher M.D. Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insight from three-dimensional and contrast echocardiography with strain rate measurement. Circulation. 2001; 104: 1952–7.
  10. Андрианов А.М., Саидова М.А. Современные возможности трансторакальной эхокардиографии в диагностике ишемической митральной недостаточности. Атмосфера. Новости кардиологии. 2015; 4: 12–3. DOI: 10.24411/2076-4189
  11. Hwang H.Y., Lim J.H., Oh S.J., Paeng J.C., Kim K.B. Improved functional mitral regurgitation after off-pump revascularization in acute coronary syndrome. Ann. Thorac. Surg. 2012; 94 (4): 1157–65. DOI: 10.1016/j.athoracsur.2012.04.118
  12. Li S., Barywani S., Fu M. Prognostic significance of mitral regurgitation in long-term all-cause mortality in patients aged ≥ 80 years with acute coronary syndrome. Int. J. Cardiol. 2014; 176 (2): 340–5. DOI: 10.1016/j.ijcard.2014.06.084
  13. Lin K.L., Hsiao S.H., Wu C.J., Kang P.L., Chiou K.R. Treatment strategies for acute coronary syndrome with severe mitral regurgitation and their effects on shortand long-term prognosis. Am. J. Cardiol. 2012; 110 (6): 800–6. DOI: 10.1016/j.amjcard.2012.05.010
  14. Голухова Е.З., Шанаурина Н.В. Роль изучения проксимальной зоны регургитации в количественной оценке недостаточности митрального клапана. Креативная кардиология. 2007; 1–2: 243–53.
  15. Pan L., Wang T. Features of cardiac remodeling in patients with acute coronary syndrome complicated with rheumatoid arthritis. Sci. Rep. 2017; 7 (1): 10268. DOI: 10.1038/s41598-017-11123-1
  16. Rao R.V., Wright D., Dokainish H. Acute mitral regurgitation in suspected acute coronary syndrome: what is the cause? Echocardiography. 2013; 30 (5): E118–20. DOI: 10.1111/echo.12296
****
  1. Almukhambetova R.K., Shuzhenova B.O., Elshibaeva A.D., Mazhibaeva A.P., Dzhigitekova B.N., Saparkyzy K.T. Functional mitral regurgitation as a risk factor in IHD. In: Actual problems of modern science. Kiev; 2016: 45–7 (in Russ.).
  2. Abdullaev A.A., Ibragimova I.B., Islamova U.A., Gafurova R.M., Baytemirova N.N. Torasemide in the prevention of progression of mitral regurgitation and chronic heart failure in the post-infarction period. Russian Journal of Cardiology. 2018; 5: 97–102 (in Russ.). DOI: 10.15829/1560-4071-2018-5-97-102
  3. Bockeria L.A., Sukhanov S.G., Orekhova E.N. (Eds) Ischemic insufficiency of atrioventricular valves. Moscow; 2011: 5–19 (in Russ.).
  4. Buziashvili Yu.I., Koksheneva I.V., Khutsurauli E.M., Arutyunova Ya.E., Makhmudov Sh.G. Features of remodeling of the left ventricle and mitral valve apparatus in patients with ischemic heart disease with progression of mitral regurgitation after surgical treatment. Cardiovascular Therapy and Prevention. 2013; 2: 30–40 (in Russ.). DOI: 10.15829/1728-8800-2013-2-30-40
  5. Timek T.A., Lai D.T., Tibayan F. Ischemia in three left ventricular regions: Insights into the pathogenesis of acute ischemic mitral regurgitation. J. Thorac. Cardiovasc. Surg. 2003; 125; 559–69. DOI: 10.1067/mtc.2003.43 6. Yosefy C., Beeri R., Guerrero J.L. Mitral regurgitation after anteroapical myocardial infarction: new mechanistic insights. Circulation. 2011; 123: 1529–36. DOI: 10.1161/CIRCULATIONAHA.110.977843
  6. Yaroslavskaya E.I., Kuznetsov V.A., Pushkarev G.S., Krinochkin D.V., Zyryanov I.P., Kolunin G.V. Mitral regurgitation and localization of coronary stenoses in patients with postinfarction cardiosclerosis. Kardiologiia. 2013; 53 (2): 55–60 (in Russ.).
  7. Sharma S.K., Seckler J., Israel D.H. Clinical, angiographic and anatomic findings in acute severe ischemic mitral regurgitation. Am. J. Cardiol. 1992; 70: 277.
  8. Borisov I.A., Dieva T.V., Chernikov N.A., Uymanova M.Yu. The possibilities of stress-echocardiography with dobutamine in the diagnosis of ischemic mitral dysfunction. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2008; 9 (3): 162 (in Russ.).
  9. Messas E., Guerrero J.L., Handschumacher M.D. Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insight from three-dimensional and contrast echocardiography with strain rate measurement. Circulation. 2001; 104: 1952–7.
  10. Andrianov A.M., Saidova M.A. Modern possibilities of transthoracic echocardiography in the diagnosis of ischemic mitral insufficiency. Atmosphere. Cardiology News. 2015; 4: 12–3 (in Russ.). DOI: 10.24411/2076- 4189
  11. Hwang H.Y., Lim J.H., Oh S.J., Paeng J.C., Kim K.B. Improved functional mitral regurgitation after off-pump revascularization in acute coronary syndrome. Ann. Thorac. Surg. 2012; 94 (4): 1157–65. DOI: 10.1016/j.athoracsur.2012.04.118
  12. Li S., Barywani S., Fu M. Prognostic significance of mitral regurgitation in long-term all-cause mortality in patients aged ≥ 80 years with acute coronary syndrome. Int. J. Cardiol. 2014; 176 (2): 340–5. DOI: 10.1016/j.ijcard.2014.06.084
  13. Lin K.L., Hsiao S.H., Wu C.J., Kang P.L., Chiou K.R. Treatment strategies for acute coronary syndrome with severe mitral regurgitation and their effects on shortand long-term prognosis. Am. J. Cardiol. 2012; 110 (6): 800–6. DOI: 10.1016/j.amjcard.2012.05.010
  14. Golukhova E.Z., Shanaurina N.V. The role of studying the proximal regurgitation zone in the quantitative assessment of mitral valve insufficiency. Creative Cardiology. 2007; 1–2: 243–53 (in Russ.).
  15. Pan L., Wang T. Features of cardiac remodeling in patients with acute coronary syndrome complicated with rheumatoid arthritis. Sci. Rep. 2017; 7 (1): 10268. DOI: 10.1038/s41598-017-11123-1
  16. Rao R.V., Wright D., Dokainish H. Acute mitral regurgitation in suspected acute coronary syndrome: what is the cause? Echocardiography. 2013; 30 (5): E118–20. DOI: 10.1111/echo.12296

About Authors

  • Leo A. Bockeria, Dr. Med. Sc., Professor, Academician of RAS and RAMS, President; ORCID
  • Aminat Kh. Dzeytova, Postgraduate; ORCID

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