Iprovement in Functional Mitral Regurgitation after Coronary Catheterization with and Without Percutaneous Coronary Intervention

Background: Functional mitral regurgitation (FMR) occurs in patients with left ventricular (LV) dysfunction and anatomically normal mitral valve. Recent observation suggested improvement in FMR post percutaneous coronary intervention (PCI).

Methods: This is a retrospective single-center analysis of patients with significant FMR (≥moderate mitral regurgitation associated with ≥moderate LV dysfunction; without mitral deformity) that underwent coronary catheterization within 6 months after echocardiography and a follow-up echocardiogram 2 to 24 months after catheterization. Patients that underwent surgery or cardiac resynchronization after catheterization and before follow-up echocardiogram were excluded. MR was graded 0-6 and LV function 0-5. Change in FMR between pre and post catheterization echocardiograms was recorded. The impact of PCI on this change was determined.

Results: One hundred and one patients were included in the study. Mean age was 67±13 yr and 30% were females. Forty patients (40%) underwent PCI that included Cx/marginal in 19, RCA in 20, left main/LAD in 10 and graft in 5 vessels; 61 patients (52% with ischemic heart disease) had diagnostic catheterization only. There was no significant difference in age, gender, hypertension, diabetes, hyperlipidemia, smoking, LV function or MR severity at baseline between PCI/non-PCI patients. At follow-up MR improved by 1 grade in 62 patients (61.4%) and by ≥2 grades in 41(40.6%). Significant correlations (Spearman) were found between improved MR and improved LV end diastolic diameter, left atrial diameter, estimated pulmonary pressure, fractional shortening and LV function (p

Conclusion: In patients referred for coronary catheterization, functional mitral regurgitation improvement is associated with improved ventricular dimensions and function. Percutaneous intervention has no effect on FMR improvement.