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Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures Transcatheter aortic-valve replacement with a self-expanding prosthesis Permanent pacemaker use among patients with heart failure and preserved ejection fraction: Findings from the Acute Decompensated Heart Failure National Registry (ADHERE) National Registry Coronary plaque redistribution after stent implantation is determined by lipid composition: A NIRS-IVUS analysis Frailty and Bleeding in Older Adults Undergoing TAVR or SAVR: Insights From the FRAILTY-AVR Study Sleep quality and risk of coronary heart disease-a prospective cohort study from the English longitudinal study of ageing Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial Expert Recommendations on Cardiac Computed Tomography for Planning Transcatheter Left Atrial Appendage Occlusion Intravascular Ultrasound-Guided Versus Angiography-Guided Implantation of Drug-Eluting Stent in All-Comers: The ULTIMATE trial Long-Term Outcomes of Anticoagulation for Bioprosthetic Valve Thrombosis

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.