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Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial 中国肺高血压诊断和治疗指南2018 Circulating MicroRNAs and Monocyte-Platelet Aggregate Formation in Acute Coronary Syndrome Fractional flow reserve vs. angiography in guiding management to optimize outcomes in non-ST-segment elevation myocardial infarction: the British Heart Foundation FAMOUS-NSTEMI randomized trial Effect of Pre-Hospital Crushed Prasugrel Tablets in Patients with STEMI Planned for Primary Percutaneous Coronary Intervention: The Randomized COMPARE CRUSH Trial Prognostic and Practical Validation of Current Definitions of Myocardial Infarction Associated With Percutaneous Coronary Intervention Deficiency of GATA3-Positive Macrophages Improves Cardiac Function Following Myocardial Infarction or Pressure Overload Hypertrophy Galectin-3 Levels and Outcomes After Myocardial Infarction: A Population-Based Study Association between Coronary Collaterals and Myocardial Viability in Patients with a Chronic Total Occlusion Incidence and Outcomes of Acute Coronary Syndrome After Transcatheter Aortic Valve Replacement
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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.
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