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Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association Translational Perspective on Epigenetics in Cardiovascular Disease A randomised trial comparing two stent sizing strategies in coronary bifurcation treatment with bioresorbable vascular scaffolds - The Absorb Bifurcation Coronary (ABC) trial Coronary CT Angiography and 5-Year Risk of Myocardial Infarction Chronic Total Occlusion Percutaneous Coronary Intervention: Evidence and Controversies OPTIMAL USE OF LIPID-LOWERING THERAPY AFTER ACUTE CORONARY SYNDROMES: A Position Paper endorsed by the International Lipid Expert Panel (ILEP) Coronary Angiography in Patients With Out-of-Hospital Cardiac Arrest Without ST-Segment Elevation: A Systematic Review and Meta-Analysis Natural History of Spontaneous Coronary Artery Dissection With Spontaneous Angiographic Healing Phosphoproteomic Analysis of Neonatal Regenerative Myocardium Revealed Important Roles of CHK1 via Activating mTORC1/P70S6K Pathway Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments: experiences from the SWEDEHEART registry 1995-2014
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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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