The Role of Ischemic Mitral Regurgitation

8/13/2019 The Role of Ischemic Mitral Regurgitation

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Pembimbing : dr. Karsito Sp.PD

Disusun oleh: Siska Desy Sofyana


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AbstractAcute mitral regurgitation may cause pulmonaryedema, but the pathogenetic role of chronic ischemicmitral regurgitation, a dynamic condition, has not yetbeen characterized.


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MethodsWe prospectively studied 28 patients (mean [SD] age,

6511 years) with acute pulmonary edema and leftventricular systolic dysfunction and 46 patientswithout a history of acute pulmonary edema.

The two groups were matched for all baseline

characteristics.Patients underwent quantitativeDoppler echocardiography during exercise.


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Results In the univariate analysis, patients with recent pulmonary edema had a

much higher increase than did the patients without pulmonary edemain mitral regurgitant volume (2614 ml vs. 514 ml, P


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ConclusionsIn patients with left ventricular systolic dysfunction,acute pulmonary edema is associated with thedynamic changes in ischemic mitral regurgitation andthe resulting increase in pulmonary vascular pressure.


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acute cardiogenic pulmonary edema is a dramatic andsometimes recurrent manifestation of heart failure.

Its pathogenesis is not fully understood. Patients can have transient episodes of increased

regurgitant

Exercise echocardiography provides a better

appreciation of the dynamic characteristics of mitralregurgitation


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Methodspatient population Prospective study. During a 36-month period, 223 consecutive patients were

identified for further evaluation

Exclusion criteria: 80 years (14 patients), acute coronary syndrome (71 patients), tachyarrhythmias (33 patients), valvular lesions (18 patients), and early death (17 patients).


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Of the 70 remaining patients, 29 hadechocardiographic evidence of preserved leftventricular systolic function (ejection fraction >45percent); 9 remained in NYHA functional class IV


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exercise echocardiography Symptom-limited, graded, bicycle exercise testing was

performed with the patients in a semisupine positionon a tilting exercise table.


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echocardiographic measurements The regurgitant volume and effective regurgitant

orifice area were calculated with use of standardformulas.

We quantified mitral regurgitation with the use ofboth the quantitative Doppler methodusing mitral

and aortic stroke volumes

and the proximalisovelocity surface area method, as previouslydescribed


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statistical analysis P value of less than 0.05 was considered to indicate

statistical significance.

To identify independent variables associated with ahistory of recent pulmonary edema, a stepwiselogistic-regression analysis was performed with the use

of Statistica software, version 5 (StatSoft).


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Results characteristics of the patientsThe acute pulmonary edema in all 28 study patients was treated

with oxygen, nitrates, and furosemide.A systolic murmur = 13.NYHA classII = 21,NYHA class III= 4NYHA class I=3 All 28

patients underwent exercise Doppler echocardiography 72 days(range, 4 to 11 days) after the acute episode. Heart rate andsystolic blood pressure were higher at the time of hospitaladmission than before the exercise test: 897 beats per minute

vs. 7511 beats per minute (P


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The Role of Ischemic Mitral Regurgitation

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