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SPECT and PET in ischemic heart failure Association of Left Ventricular Systolic Function With Incident Heart Failure in Late Life Meta-analysis of outcomes after intravascular ultrasound-guided versus angiography-guided drug-eluting stent implantation in 26,503 patients enrolled in three randomized trials and 14 observational studies A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure Association Between Functional Impairment and Medication Burden in Adults with Heart Failure The Prevalence of Myocardial Bridging Associated with Coronary Endothelial Dysfunction in Patients with Chest Pain and Non-Obstructive Coronary Artery Disease Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention Timing of Intervention in Aortic Stenosis Baseline Features of the VICTORIA (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction) Trial Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure
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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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