CBS 2019
CBSMD教育中心
English

科学研究

科研文章

荐读文献

Pulmonary Artery Denervation: An Alternative Therapy for Pulmonary Hypertension Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty Clinical Outcome of Double Kissing Crush Versus Provisional Stenting of Coronary Artery Bifurcation Lesions: The 5-Year Follow-Up Results From a Randomized and Multicenter DKCRUSH-II Study (Randomized Study on Double Kissing Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions) Retrospective Comparison of Long-Term Clinical Outcomes Between Percutaneous Coronary Intervention and Medical Therapy in Stable Coronary Artery Disease With Gray Zone Fractional Flow Reserve - COMFORTABLE Retrospective Study Updated clinical classification of pulmonary hypertension Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation Clinical Predictors for Lack of Favorable Vascular Response to Statin Therapy in Patients With Coronary Artery Disease: A Serial Optical Coherence Tomography Study Optimal threshold of postintervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis Long-term outcomes of routine versus provisional T-stenting for de novo coronary bifurcation lesions: five-year results of the Bifurcations Bad Krozingen I study Assessment of the coronary calcification by optical coherence tomography

Review Article2020 Dec 18;S0828-282X(20)31146-6.

JOURNAL:Can J Cardiol. Article Link

Pathophysiology, diagnosis and new therapeutic approaches for ischemic mitral regurgitation

S Hadjadj, O Marsit, J-M Paradis et al. Keywords: ischemic mitral regurgitation; diagnosis; therapy

ABSTRACT

Ischemic mitral regurgitation is a valvular complication frequently seen in patients with coronary artery disease and associated with increased mortality and morbidity. Ischemic mitral regurgitation has a complex, heterogeneous and still incompletely understood pathophysiology involving both the mitral valve and the left ventricle. The occurrence of valve regurgitation in patients with ischemic cardiomyopathy will in return accelerate left ventricular remodeling and dysfunction, ultimately leading to irreversible heart failure. Diagnostic evaluation of ischemic mitral regurgitation is unique and different from the other causes of mitral regurgitation. The severity thresholds associated with outcomes are different from primary MR, and specific imaging characteristics are potentially useful to guide therapy. The use of imaging modalities such as 3D echocardiography and cardiac MRI can refine the diagnostic evaluation and help to choose the correct management. While multiple treatments are available to improve ischemic mitral regurgitation, each therapeutic option is associated with limitations and incomplete success. Therapy has therefore to be individualized for each patient. Current options include optimal medical therapy, cardiac resynchronization, percutaneous or surgical revascularization, surgical mitral repair or replacement and new percutaneous interventions. The current manuscript aims to discuss the last insights on the pathophysiology, diagnosis and treatments of ischemic mitral regurgitation.
Mitral regurgitation (MR) is a frequent disease with significant morbidity 
 
. There are multiple causes to MR, each with their own management strategies. Secondary (or functional) MR occurs in response to a primary left ventricle (LV) disease and currently represents a formidable therapeutic challenge. While clearly associated with adverse prognosis, few treatments have been shown to influence clinical outcomes in this population. Most data for secondary MR are derived from patients with ischemic heart disease, in which case the term ischemic MR is used. Ischemic MR has a complex physiology involving both the LV and the mitral leaflets. Multiple characteristics are making the diagnostic evaluation and treatment of ischemic MR unique and distinct from the other causes of MR.