Effect of Ischemic Mitral Regurgitation on the Ratio of Early Transmitral Flow Velocity to Mitral Annulus Early Diastolic Velocity in Patients With Stable Coronary Artery Disease

Abstract

The present study evaluated the prevalence of ischemic mitral regurgitation (MR) in a large population of patients with documented coronary artery disease who had been referred for echocardiography and assessed whether ischemic MR is an independent determinant of echocardiographically estimated left ventricular (LV) filling pressures. We studied 849 consecutive patients with coronary artery disease (67 +/- 10 years; 76% men) without organic valvular disease. Ischemic MR was semiquantitatively graded as absent or trace or grades 1 to 3/4 by assessment of the color flow jet in relation to the left atrium in multiple orthogonal views. The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity was determined to estimate LV filling pressures. Ischemic MR was absent in 25% of patients and 28% had grade > or = 2 ischemic MR. Only 18% of patients with preserved LV function had a significant ischemic MR, but up to 66% of patients with poor LV function had grade > or = 2 MR. The ratio of early transmitral flow velocity to mitral annulus early diastolic velocity was independently predicted by age, gender, LV ejection fraction, and ischemic MR severity. Even mild ischemic MR was associated with an increase in this noninvasive marker of LV filling pressures.