Influence of concomitant pathology on the clinical course of ischemic mitral regurgitation and on the choice of mitral valve surgical correction tactics

Objective. To determine the features of the clinical course of ischemic mitral regurgitation depending on the surgical correction of the mitral valve. Materials and methods. The study involved 140 patients with ischaemic mitral regurgitation (99 men and 41 women) who underwent myocardial revascularisation and mitral valve reconstruction – its plastic (experimental group) or prosthetic (control group). The average age of the patients was (65.9 ± 4.0) years. All patients had a history of coronary heart disease and ischaemic mitral regurgitation. The data of primary medical records were analysed: medical histories, primary medical records, physical, clinical, laboratory and instrumental examinations, as well as protocols of surgical interventions. Results. The peculiarities of the clinical course and development of ischaemic mitral regurgitation were established. Among the complaints of patients with mitral regurgitation in the setting of coronary heart disease, dyspnoea, chest pain and decreased exercise tolerance prevailed. When studying the existing concomitant pathology (arterial hypertension, myocardial infarction and mitral insufficiency), certain differences between the study and control groups were identified. The incidence of severe mitral insufficiency was statistically significantly higher in the control group (p = 0.03; χ2 = 4.69), and the incidence of moderate mitral insufficiency was statistically significantly higher in the study group (p = 0.05, χ2 = 3.74). In the control group, the incidence of myocardial infarction was statistically significantly higher (p = 0.04, χ2 = 4.09) and the incidence of grade III hypertension (p = 0.008, χ2 = 6.93), and in the study group, the incidence of grade II hypertension was statistically significantly higher (p = 0.01, χ2 = 6.08). Conclusions. Comorbidities affect the clinical course of ischaemic mitral regurgitation and the choice of tactics for mitral valve surgery. The patients' complaints were dominated by those of the intervention group: shortness of breath with mild physical exertion and pain behind the sternum and in the heart. The control group differed from the study group in the following specific features of the clinical course of ischaemic mitral regurgitation The onset of arterial hypertension was 4.8 years earlier and, accordingly, its duration was 5.7 years longer; statistically significantly higher rates of grade III hypertension (p = 0.008, χ2 = 6.93), myocardial infarction (p = 0.04, χ2 = 4.09) and severe mitral insufficiency (p = 0.03; χ2 = 4.69).