title: Effect of myocardial perfusion pattern on frequency and severity of mitral regurgitation in patients with known or suspected coronary artery disease.
abstract: Mitral regurgitation (MR) is common with coronary artery disease as altered myocardial substrate can affect valve performance. Single-photon emission computed tomography myocardial perfusion imaging (MPI) enables assessment of myocardial perfusion alterations. This study examined perfusion pattern in relation to MR. A total of 2,377 consecutive patients with known or suspected coronary artery disease underwent stress MPI and echocardiography within 1.6 ± 2.3 days. MR was present on echocardiography in 34% of patients, among whom 13% had advanced (moderate or more) MR. MR prevalence was higher in patients with abnormal MPI (44% vs 29%, p <0.001), corresponding to increased global ischemia (p <0.001). Regional perfusion varied in left ventricular segments adjacent to each papillary muscle: adjacent to the anterolateral papillary muscle, magnitude of baseline and stress-induced anterior/anterolateral perfusion abnormalities was greater in patients with MR (both p <0.001). Adjacent to the posteromedial papillary muscle, baseline inferior/inferolateral perfusion abnormalities were greater with MR (p <0.001), whereas stress inducibility was similar (p = 0.39). In multivariate analysis, stress-induced anterior/anterolateral and rest inferior/inferolateral perfusion abnormalities were independently associated with MR (both p <0.05) even after controlling for perfusion in reference segments not adjacent to the papillary muscles. MR severity increased in relation to magnitude of perfusion abnormalities in each territory adjacent to the papillary muscles, as evidenced by greater prevalence of advanced MR in patients with at least moderate anterior/anterolateral stress perfusion abnormalities (10.7% vs 3.6%), with similar results when MR was stratified based on rest inferior/inferolateral perfusion (10.4% vs 3.0%, both p <0.001). In conclusion, findings demonstrate that myocardial perfusion pattern in left ventricular segments adjacent to the papillary muscles influences presence and severity of MR.
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Volo
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Sergey
authors.initials: S
authors.lastname: Gurevich
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Maya
authors.initials: M
authors.lastname: Petashnick
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Polydoros
authors.initials: P
authors.lastname: Kampaktsis
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Attila
authors.initials: A
authors.lastname: Feher
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Szulc
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Franklin J
authors.initials: FJ
authors.lastname: Wong
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: James K
authors.initials: JK
authors.lastname: Min
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.affiliation: Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Radiology, Weill Cornell Medical College, New York, New York. Electronic address: jww2001@med.cornell.edu.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D003326:Coronary Circulation / Q000502:physiology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*