Left ventricular function in ischemic mitral regurgitation--a precatheterization assessment

The clinical characteristics of 150 patients with unstable ischemic heart disease were evaluated for the ability to diagnose mitral regurgitation (MR). A careful assessment of physical findings, ECG- and radionuclide-determined global and regional left ventricular function was performed in all patients to characterize the population with ischemic MR. Twenty-nine patients were found to have MR and in 65% the degree of MR was 2+ or more. All of the patients with significant MR had a systolic murmur on physical examination, and although this finding was 90% sensitive for MR it had a poor predictive value (42%). Even a characteristic apical holosystolic murmur, although specific for MR (90%), had a low sensitivity and predictive value. Two regional wall motion abnormalities (inferoposterior akinesis and apical dyskinesis with an ejection fraction less than or equal to 35%) identified 26 of 29 patients with MR and all with 2+ or more MR, as well as the 10 patients who required mitral valve replacement in addition to coronary artery bypass grafting. This finding was complementary to the results of physical examination and when used together improved the diagnostic accuracy of identifying MR. The radionuclide regurgitant index was evaluated for its predictive value in assessing MR in this group of patients but was found to be a poor discriminator in patients with abnormal ejection fractions and regional wall motion abnormalities. The precatheterization assessment of left ventricular function with radionuclide angiography can provide important insight into the presence of ischemic MR.