Document Detail

Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery.
MedLine Citation:
PMID:  19786637     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery. METHODS AND RESULTS: The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001). CONCLUSIONS: Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.
Martin Penicka; Hana Linkova; Otto Lang; Richard Fojt; Viktor Kocka; Marc Vanderheyden; Jozef Bartunek
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2009-09-28
Journal Detail:
Title:  Circulation     Volume:  120     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-10-13     Completed Date:  2009-11-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1474-81     Citation Subset:  AIM; IM    
Department of Cardiology, Third Faculty of Medicine Charles University in Prague, Ruska 87, 10004 Prague, Czech Republic.
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MeSH Terms
Coronary Artery Bypass* / trends
Follow-Up Studies
Middle Aged
Mitral Valve Insufficiency / radionuclide imaging*,  surgery*
Myocardial Ischemia / radionuclide imaging*,  surgery*
Predictive Value of Tests
Prospective Studies
Surgical Procedures, Elective* / trends
Tomography, Emission-Computed, Single-Photon / trends
Treatment Failure
Treatment Outcome
Comment In:
Circulation. 2009 Oct 13;120(15):1459-61   [PMID:  19786629 ]

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