Myocardial perfusion pattern for stratification of ischemic mitral regurgitation response to percutaneous coronary
Parag Goyal1, Jiwon Kim, Attila Feher
1aDepartment of Medicine, Greenberg Cardiology Division, Weill Cornell Medical College, New York, New York Departments of bSurgery cBioengineering, University of California dVeterans Affairs Medical Center, San Francisco, California eDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Objective:
Ischemic mitral regurgitation (MR) is common, but its response to percutaneous coronary intervention (PCI) is poorly understood. This study tested the utility of myocardial perfusion imaging (MPI) for the stratification of MR response to PCI.
Methods:
MPI and transthoracic echocardiography (echo) were performed among patients undergoing PCI. MPI was used to assess stress/rest myocardial perfusion. MR was assessed via echo (performed before and after PCI).
Results:
A total of 317 patients with abnormal myocardial perfusion on MPI underwent echo 25±39 days before PCI. MR was present in 52%, among whom 24% had advanced (≥moderate) MR. MR was found to be associated with left ventricular (LV) chamber dilation on MPI and echo (both P<0.001). The magnitude of global LV perfusion deficits increased in relation to MR severity (P<0.01). Perfusion differences were greatest for global summed rest scores, which were 1.6-fold higher among patients with advanced MR versus those with mild MR (P=0.004), and 2.4-fold higher versus those without MR (P<0.001). In multivariate analysis, advanced MR was found to be associated with a fixed perfusion defect size on MPI [odds ratio 1.16 per segment (confidence interval 1.002-1.34), P=0.046], independent of LV volume [odds ratio 1.10 per 10 ml (confidence interval 1.04-1.17), P=0.002]. Follow-up via echo (1.0±0.6 years) demonstrated MR to decrease (≥1 grade) in 31% of patients and increase in 12% of patients. Patients with increased MR after PCI had more severe inferior perfusion defects on baseline MPI (P=0.028), whereas defects in other distributions and LV volumes were similar (P=NS).
Conclusion:
The extent and distribution of single-photon emission computed tomography-evidenced myocardial perfusion defects impact MR response to revascularization. An increased magnitude of inferior fixed perfusion defects predicts post-PCI progression of MR.
Insights
Myocardial perfusion imaging (MPI) helps predict ischemic mitral regurgitation (MR) response to percutaneous coronary intervention (PCI). Extensive inferior perfusion defects on MPI indicate a higher risk of MR worsening after PCI.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiac Imaging
Background:
- Ischemic mitral regurgitation (MR) is a frequent complication of coronary artery disease.
- The response of ischemic MR to percutaneous coronary intervention (PCI) remains incompletely understood.
- Myocardial perfusion imaging (MPI) assesses myocardial blood flow and viability.
Purpose of the Study:
- To evaluate the utility of MPI in stratifying patients with ischemic MR undergoing PCI.
- To determine if MPI findings can predict the response of MR to PCI.
Main Methods:
- 317 patients with abnormal MPI underwent transthoracic echocardiography (echo) before PCI.
- MPI assessed stress/rest myocardial perfusion; echo evaluated MR severity and left ventricular (LV) dimensions.
- Follow-up echo assessed MR changes after PCI.
Main Results:
- 52% of patients had MR, with 24% having advanced (≥moderate) MR.
- Advanced MR correlated with LV dilation and larger perfusion defects on MPI (P<0.01).
- Increased MR post-PCI was associated with more severe inferior perfusion defects on baseline MPI (P=0.028).
Conclusions:
- The extent and distribution of myocardial perfusion defects on MPI influence MR response to PCI.
- Inferior fixed perfusion defects on MPI predict the progression of MR after PCI.
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