Abstract 12437: Prediction of Mitral Regurgitation Progression With Advanced Ischemic Cardiomyopathy - A Multi-Modality Study

Abstract

Introduction: Ischemic mitral regurgitation (IMR) is associated with poor outcomes. Determining risk for the presence and progression of IMR may be critical for risk stratification. Hypothesis: We hypothesize that a multi-modality approach can evaluate the progression of IMR in patients with advanced ischemic cardiomyopathy (ICM) and create a risk model for the prediction of IMR progression. Methods: Consecutive ICM patients who underwent cardiac magnetic resonance (CMR) and echocardiograms at baseline with echocardiographic follow-up were included. CMR was used to assess global and regional left ventricular (LV) remodeling, myocardial scarring, and mitral valve geometry. The effective regurgitant orifice area (EROA) was calculated from the proximal isovelocity surface area by echocardiography. We identified the best performing model for prediction of worsening IMR based on the c-index. Results: We evaluated 693 patients (age 62±11). The following factors were independently predictive of an increased EROA at baseline (n=693): higher total scar% (p=0.002) and higher ESVi (p<0.001). In regards to progression of IMR over time, the following variables were independently predictive (n=481): older age (p=0.015), lower GFR (p<0.001), higher EROA at baseline (p<0.001), lower tenting area (p=0.008), higher ESVi (p=0.001), and the interaction of total scar % and treatment type (medical vs revascularization vs valve surgery, Figure) (p=0.001). The c-index for worsened IMR prediction for the ICM was 0.730 from our training sample (n=164). Conclusions: The variables which predict IMR at baseline and progression of IMR over time slightly differ. Higher total scar% and higher ESVi are independently associated with increasing IMR at baseline. However, higher EROA at baseline, lower tenting area, higher ESVi and total scar% * treatment type were associated with progression of IMR over time. The risk model of IMR progression was moderately predictive in this cohort.