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Related Experiment Videos

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

W M Breisblatt1, M Cerqueira, C K Francis

  • 1Cardiology Section, Wilford Hall United States Air Force Medical Center, San Antonio, TX 78236-5300.

American Heart Journal
|January 1, 1988
PubMed
Summary

Diagnosing mitral regurgitation (MR) in unstable ischemic heart disease patients is challenging. Regional wall motion abnormalities, particularly inferoposterior akinesis and apical dyskinesis, significantly aid in identifying significant MR.

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Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Diagnostic Imaging

Background:

  • Unstable ischemic heart disease (UIHD) poses diagnostic challenges for coexisting conditions.
  • Mitral regurgitation (MR) is a significant complication in UIHD, impacting patient outcomes.
  • Accurate diagnosis of MR in UIHD is crucial for guiding treatment strategies.

Purpose of the Study:

  • To evaluate the clinical characteristics for diagnosing mitral regurgitation (MR) in patients with unstable ischemic heart disease (UIHD).
  • To assess the diagnostic accuracy of physical findings and left ventricular function assessments for identifying ischemic MR.
  • To determine the utility of radionuclide angiography in predicting MR severity in this patient cohort.

Main Methods:

  • Clinical assessment of 150 UIHD patients, including physical examination and ECG.

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  • Radionuclide-determined global and regional left ventricular function analysis.
  • Evaluation of radionuclide regurgitant index for MR prediction.

    • Main Results:

    • Twenty-nine patients (19%) had MR, with 65% having moderate to severe MR (2+ or more).
    • Systolic murmurs were sensitive but had poor predictive value for MR (42%).
    • Specific regional wall motion abnormalities (inferoposterior akinesis, apical dyskinesis with EF ≤35%) identified 90% of MR patients and were crucial for identifying severe MR and those needing valve surgery.

    Conclusions:

    • Regional left ventricular wall motion abnormalities are highly valuable for diagnosing ischemic MR in UIHD patients.
    • Combining physical exam with radionuclide assessment of ventricular function improves MR diagnostic accuracy.
    • Radionuclide regurgitant index is unreliable in patients with abnormal ejection fractions and regional wall motion abnormalities.