Predictive Value of Viable Myocardium of Papillary Muscle-Ventricular Wall Complex for Improvement in Moderate Ischemic Mitral Regurgitation

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-03-01 DOI:10.1016/j.cjco.2024.11.021

Zhiepng Wei MD , Enjun Zhu MD , Zhiyong Shi MD , Tong Tan MD , Ke Zhang MD , Zhihui Zhu MD , Shengwei Wang MD , Xiaoli Zhang MD , Yongqiang Lai MD

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Abstract

Background

Performing a mitral valve procedure during coronary artery bypass grafting (CABG) in patients with coronary artery disease complicated by moderate ischemic mitral regurgitation (IMR) remains controversial. This study aimed to assess the benefit of isolated CABG and to develop a new index of viable myocardium within the papillary muscle-ventricular wall complex (VM-PM-VWC) to predict the improvement of IMR by CABG alone.

Methods

In total, 122 patients (age, 62.34 ± 8.53 years; 78.70% male) with moderate IMR who underwent CABG alone at Beijing Anzhen Hospital were retrospectively analyzed. All patients underwent ^99mTc-sestamibi single-photon emission computed tomography (SPECT) and ¹⁸-fluorine fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET) to evaluate the VM-PM-VWC. Based on the postoperative echocardiography results at 1-year follow-up, patients were divided into IMR-unimproved (moderate or severe IMR, n = 38) and IMR-improved (no or mild IMR, n = 84) groups. Factors associated with improvement were analyzed by multivariate logistic regression.

Results

The VM-PM-VWC was an independent factor for moderate IMR improvement (odds ratio, 1.16; 95% confidence interval [CI], 1.09-1.24; P < 0.001). The cutoff value for moderate IMR improvement was 12.50%, with a sensitivity and specificity of 76.32% and 80.95%, respectively (area under the curve [AUC] 0.830; 95% CI, 0.741-0.919; P < 0.001). During a median follow-up of 3.71 (interquartile range: 2.17-5.10) years, major cardiovascular and cerebrovascular event-free survival was higher in the improved group than in the unimproved group (P < 0.001).

Conclusions

Most patients with moderate IMR improved from isolated CABG. The VM-PM-VWC was an independent predictor of IMR improvement, which could help surgical decision making.

Clinical Trial Registration

ChiCTR2100042454.

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背景在冠状动脉旁路移植术（CABG）期间为并发中度缺血性二尖瓣反流（IMR）的冠心病患者实施二尖瓣手术仍存在争议。本研究旨在评估单独 CABG 的益处，并建立乳头肌-室壁复合体（VM-PM-VWC）内存活心肌的新指标，以预测单独 CABG 对 IMR 的改善情况。方法回顾性分析了在北京安贞医院接受单独 CABG 的 122 例中度 IMR 患者（年龄为 62.34 ± 8.53 岁；78.70% 为男性）。所有患者均接受了 99mTc-sestamibi 单光子发射计算机断层扫描（SPECT）和 18 氟脱氧葡萄糖正电子发射计算机断层扫描（18F-FDG PET），以评估 VM-PM-VWC。根据术后1年随访的超声心动图结果，将患者分为IMR未改善组（中度或重度IMR，38人）和IMR改善组（无或轻度IMR，84人）。结果 VM-PM-VWC 是中度 IMR 改善的独立因素（几率比 1.16；95% 置信区间 [CI]，1.09-1.24；P <；0.001）。中度 IMR 改善的临界值为 12.50%，敏感性和特异性分别为 76.32% 和 80.95%（曲线下面积 [AUC] 0.830; 95% CI, 0.741-0.919; P <0.001）。在中位随访 3.71 年（四分位间距：2.17-5.10）期间，病情好转组的无重大心脑血管事件生存率高于病情未好转组（P <0.001）。临床试验注册ChiCTR2100042454。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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