Related Experiment Videos
Mitral regurgitation in coronary heart disease
Insights
Mitral regurgitation is common in coronary heart disease, particularly after myocardial infarction. Severity of coronary artery disease and left ventricular dysfunction increase its incidence, though clinical signs like murmurs are not always present.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Mitral regurgitation is a frequent complication of coronary heart disease.
- Its prevalence and clinical presentation in patients undergoing cardiac surgery require further investigation.
Purpose of the Study:
- To determine the incidence and clinical significance of mitral regurgitation in patients with coronary heart disease.
- To identify predictors of mitral regurgitation in this population.
Main Methods:
- Retrospective analysis of 127 patients selected for coronary or left ventricular surgery.
- Clinical assessment, electrocardiography, chest X-ray, and angiography were used.
- Correlation of mitral regurgitation severity with coronary artery disease extent and left ventricular function.
Main Results:
- The incidence of mitral regurgitation was 31% (39 patients).
- Patients with a history or ECG evidence of myocardial infarction had a higher incidence.
- Severe coronary artery disease, reduced left ventricular ejection fraction, and elevated left ventricular end-diastolic pressure were associated with increased mitral regurgitation.
- Left atrial enlargement and pulmonary venous hypertension were reliable indicators of mitral regurgitation, while murmurs were absent in 39% of cases.
Conclusions:
- Mitral regurgitation is a significant finding in coronary heart disease, especially with more severe disease and left ventricular dysfunction.
- Clinical and radiological signs like left atrial enlargement and pulmonary venous hypertension are valuable indicators.
- The absence of a murmur does not rule out mitral regurgitation.
Abstract:
Mitral reguritation is a relatively common finding in coronary heart disease. In this series of 127 patients, selected with a view to coronary or left ventricular surgery on the basis of severity of symptoms, the incidence was 39 (31%). Mitral regurgitation is significantly more common in patients with a history or electrocardiographic evidence of previous myocardial infarction. Clinically it may present as a pan- or late systolic or even a mid-systolic, ejection type murmur at the apex or at the left sternal edge; but in 39 per cent of the patients with angiographic mitral regurgitation no murmur was present. Angiographically important mitral regurgitation (grades 2-4/4) was usually associated with a systolic murmur; this finding was independent of ejection fractions. Left ventricular enlargement clinically or radiographically is likely to accompany mitral regurgitation but left atrial enlargement (electrocardiographically or on chest x-ray) is a more reliable pointer to mitral regurgitation and pulmonary venous hypertension is even more strongly suggestive of its presence. The electrocardiographic signs of papillary muscle infarction were rare in this series (15%) and were not related to angiographic mitral regurgitation. There was no difference in the incidence of mitral regurgitation in association with anterior or inferior myocardial infarction or in distribution of coronary artery disease. There is, however, a higher incidence of mitral regurgitation in more severe coronary arterial disease (P less than 0-05). The incidence of mitral regurgitation is significantly higher with reduction in left ventricular ejection fraction (P less than 0-001), with rise in the left ventricular end-diastolic pressure (P less than 0-02), and with abnormal contraction patterns, but the severity of mitral regurgitation is not significantly related to these findings.