The Effect of Revascularization Treatment in Moderate Ischemic Mitral Regurgitation

Objective: Although it is known that revascularization is useful for the treatment of patients with ischemic mitral regurgitation (MR), the effects of revascularization on MR have not been well examined. In this study, we aimed to show the effect of revascularization alone on patients with moderate schemic MR, quantitatively and prospectively. Methods: Forty-seven patients with moderate MR (2 to 3 +) who were offered revascularization due to the diagnosis of coronary artery disease were enrolled in the study. Patients were divided into three groups according to their treatments. Patients who underwent percutaneous coronary intervention (PCI) were defined as group 1 (n=18), patients who underwent surgical revascularization (CABG) as group 2 (n=17) and patients who received medical treatment as group 3 (n=12). Transthoracic echocardiography (TTE) was performed on all patients at the beginning of the study, and after three months. Semi-quantitative (I-IV) and quantitative (EOA, RV , and RF) parameters were calculated for MR grading. Results: MR parameters of three groups were similar for TTE, performed at the beginning of the study. When the initial and the third month MR parameters of patients were compared, there was a significant decrease in group 1 in effective orifice area (EOA) (p=0.002), regurgitant volume (RV) (p=0.005), regurgitant fraction (RF) (p=0.002) and semi-quantitative MR (p=0.002). There was also a similar significant decrease in group 2 in EOA (p=0.002), RV (p=0.001), RF (p=0.001) and semi-quantitative MR (p=0.005) grades. However, EOA (p=0.10), RV (p=0.19), RF (p=0.07) and semi- quantitative MR grades (p=0.48) of group 3 patients were found to be similar to initial parameters. There was no difference between groups when residual MR grades at the third month were compared with each other (p>0.05). Conclusion: Our study showed that percutaneous or surgical revascularization significantly improved MR parameters, on the other hand there was no difference obtained with medical treatment. However, it was found that revascularization alone was related with important residual MR in the treatment of patients with ischemic MR. For this reason it can be suggested that revascularization is effective but not sufficient for the treatment of patients with ischemic MR.