Ischemic Mitral Regurgitation: A Multifaceted Syndrome with Evolving Therapies.

Mattia Vinciguerra,David Rose,Sara Cimino,Ernesto Greco,Francesco Grigioni,Giovanni Benfari,Antonio De Bellis,Cristiano Spadaccio,Silvia Romiti

doi:10.3390/biomedicines9050447

Abstract

Dysfunction of the left ventricle (LV) with impaired contractility following chronic ischemia or acute myocardial infarction (AMI) is the main cause of ischemic mitral regurgitation (IMR), leading to moderate and moderate-to-severe mitral regurgitation (MR). The site of AMI exerts a specific influence determining different patterns of adverse LV remodeling. In general, inferior-posterior AMI is more frequently associated with regional structural changes than the anterolateral one, which is associated with global adverse LV remodeling, ultimately leading to different phenotypes of IMR. In this narrative review, starting from the aforementioned categorization, we proceed to describe current knowledge regarding surgical approaches in the management of IMR.

Highlights

Published: 21 April 2021The right coaptation of mitral valve (MV) leaflets is achieved thanks to the balance between closing forces generated by contraction of the left ventricle (LV) and tethering forces of the subvalvular apparatus preventing leaflet prolapse into the atrium [1].Secondary mitral regurgitation (SMR) is a consequence of geometrical modification of the mitral valve (MV) apparatus without leaflet abnormalities.Dilated cardiomyopathy (DCM), regardless of its etiology, often leads to SMR, due to the changes in LV shape [2]
COAPT trial showed the effectiveness and safety analysis better in the intervention group, MITRA-FR fails to demonstrate any improvements in the prognosis of patients treated with percutaneous MV repair in comparison with the control group [111,112]
In comparison to MITRA-FR, LV size in COAPT was smaller whereas functional mitral regurgitation (FMR) was more severe (ERO ≈ 0.41 cm2 vs. 0.31 cm2 ), characterizing treated cases for a disproportionate grade of MR when correlated to LV adverse remodeling, as postulated by Grayburn et al [115]

Summary

Introduction

Published: 21 April 2021The right coaptation of mitral valve (MV) leaflets is achieved thanks to the balance between closing forces generated by contraction of the left ventricle (LV) and tethering forces of the subvalvular apparatus preventing leaflet prolapse into the atrium [1].Secondary mitral regurgitation (SMR) is a consequence of geometrical modification of the mitral valve (MV) apparatus without leaflet abnormalities.Dilated cardiomyopathy (DCM), regardless of its etiology, often leads to SMR, due to the changes in LV shape [2]. The right coaptation of mitral valve (MV) leaflets is achieved thanks to the balance between closing forces generated by contraction of the left ventricle (LV) and tethering forces of the subvalvular apparatus preventing leaflet prolapse into the atrium [1]. Secondary mitral regurgitation (SMR) is a consequence of geometrical modification of the mitral valve (MV) apparatus without leaflet abnormalities. According to the general classification, the presence of coronary artery disease (CAD) affecting LV geometry and function, allows differentiation between ischemic mitral regurgitation (IMR) and functional mitral regurgitation (FMR) [3]. Impaired LV contractility due to chronic ischemia or acute myocardial infarction (AMI), often in the context of heart failure with reduced ejection fraction (HFrEF), leads to moderate and moderate-to-severe mitral regurgitation (MR) in 50% and 10% of patients, respectively [2,4,5].

Methods

Results

Conclusion