Author + information
- Deborah Kwon,
- Joao Cavalcante,
- Randall Starling,
- Milind Desai,
- Scott Flamm,
- Thomas Marwick and
- Rory Hachamovitch
Controversy remains regarding how to manage patients with significant mitral regurgitation (MR) and severe ischemic cardiomyopathy (ICM). We sought to assess the impact of significant MR in the setting of subsequent incomplete revascularization (IR) with jeopardized myocardium (JM) in patients with severe ICM.
We studied 411 pts with ICM (LV dysfunction with ≥70% stenosis in ≥1 epicardial coronary artery) undergoing DE-MRI (Avanto, Siemens) between 2002-2006. Scar was defined as ≥2SD of the remote myocardium. IR was identified when ≥70% stenosis in a major coronary vessel with <50% scar did not undergo RVS of the corresponding vascular territory. A multivariable Cox proportional hazards (CPH) model was used to evaluate the association of IR and MR with survival.
Of 411 pts (mean LVEF 23±9%, mean ESVi 115±48 ml, mean scar % 30 ± 17%, 224 underwent complete RVS (Revasc no IR), 57 had incomplete RVS (Revasc IR). 121 patients with no JM were medically treated,(MedRx no IR) and 70 pts with JM were medically treated (Medrx IR). 186 deaths (45%) occurred over a mean 5.5y follow-up. MR (χ2 22.3 p = 0.0005) and IR (χ2 32.37 p=0.0012), in the setting of MedRx vs Revasc, were independently associated with mortality. A significant interaction between MR and IR demonstrated the impact of MR on survival after subsequent incomplete RVS, χ2 10.66, p =0.031 (Figure 1).
Increasing MR in the setting of subsequent IR results in increased mortality in patients with severe ICM.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Multimodality Imaging in Valvular Heart Disease
Abstract Category: 20. Imaging: CT/Multimodality
Presentation Number: 1270-350
- 2013 American College of Cardiology Foundation