Key result
CABG alone compared to CABG with mitral annuloplasty resulted in similar 12-month rates of the composite endpoint of death, cardiovascular hospitalization, or stroke.
Why the study?
Recurrences of ischemic mitral regurgitation occur after CABG alone or with annuloplasty, warranting evaluation of mitral deformation indices to predict recurrence after CABG alone.
Do preoperative mitral deformation indices during low-dose dobutamine echocardiography predict the recurrence of ischemic mitral regurgitation at 12 months in patients undergoing CABG alone?
Cohort (n=145)
Do preoperative mitral deformation indices during low-dose dobutamine echocardiography predict the recurrence of ischemic mitral regurgitation at 12 months in patients undergoing CABG alone?
Preoperative stress echocardiography assessing mitral deformation indices can identify patients with ischemic mitral regurgitation at high risk of recurrence if treated with CABG alone, aiding in surgical decision-making.
Answers are grounded in this paper and cite their sources.
Similar outcomes with CABG alone or plus annuloplasty in this cohort; leaves open whether mitral deformation indices on dobutamine echo predict IMR recurrence.
Purpose: Although coronary artery bypass grafting alone (CABGa), or, with mitral annuloplasty (CABGmp), is considered the best therapeutic strategy for patients with ischemic mitral regurgitation (IMR), some recurrences are still reported. The aim of this study was to evaluate the use of the mitral deformation indices (MDI) as a predictor of recurrence of mitral regurgitation in a 12-month follow-up after CABG alone. Methods: A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Mitral valve morphology, left ventricle function, IMR degree as assessed by effective regurgitation orifice area (ERO), myocardial viability, and MDI were assessed prior to surgery. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55) based on clinical assessment, and the results of rest and stress echocardiography (exercise echocardiography and low dose dobutamine echocardiography-DBX). One year after surgery, each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify the factors of recurrence of IMR in 1 year follow-up. Serial echo examinations were performed in all patients at discharge, and at 1 and 12 months after surgery. Results: Logistic regression analysis revealed that in CABGa, group preoperative changes of tenting area (TA) and coaptation high (CH) during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm2 provided a sensitivity of 90% and specificity of 29%, (AUC 0.6436). The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups (CABGa vs. CABGmp) no significant differences were observed in 12-month mortality (1.2% vs. 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs. 8.5%; p = 0.72), and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs. 8.5%; p = 0.742). Conclusions: The preoperative assessment of MDI changes during dbx can be used to identify patients with IMR qualified to CABG alone at increased risk of recurrence of IMR in 1 year follow-up. Mitral deformation analysis should be used for a better qualification of patients with IMR to the exact surgical approach.
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Piątkowski et al. (2021) conducted a cohort in ischemic mitral regurgitation (n=145). CABG alone vs. CABG with mitral annuloplasty was evaluated on composite endpoint (deaths/CV hosp/stroke) (p=0.742). CABG alone compared to CABG with mitral annuloplasty resulted in similar 12-month rates of the composite endpoint of death, cardiovascular hospitalization, or stroke.
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