title: Myocardial perfusion pattern for stratification of ischemic mitral regurgitation response to percutaneous coronary intervention.
abstract: OBJECTIVE
  Ischemic mitral regurgitation (MR) is common, but its response to percutaneous coronary intervention (PCI) is poorly understood. This study tested the utility of myocardial perfusion imaging (MPI) for the stratification of MR response to PCI.
  
  
  METHODS
  MPI and transthoracic echocardiography (echo) were performed among patients undergoing PCI. MPI was used to assess stress/rest myocardial perfusion. MR was assessed via echo (performed before and after PCI).
  
  
  RESULTS
  A total of 317 patients with abnormal myocardial perfusion on MPI underwent echo 25±39 days before PCI. MR was present in 52%, among whom 24% had advanced (≥moderate) MR. MR was found to be associated with left ventricular (LV) chamber dilation on MPI and echo (both P<0.001). The magnitude of global LV perfusion deficits increased in relation to MR severity (P<0.01). Perfusion differences were greatest for global summed rest scores, which were 1.6-fold higher among patients with advanced MR versus those with mild MR (P=0.004), and 2.4-fold higher versus those without MR (P<0.001). In multivariate analysis, advanced MR was found to be associated with a fixed perfusion defect size on MPI [odds ratio 1.16 per segment (confidence interval 1.002-1.34), P=0.046], independent of LV volume [odds ratio 1.10 per 10 ml (confidence interval 1.04-1.17), P=0.002]. Follow-up via echo (1.0±0.6 years) demonstrated MR to decrease (≥1 grade) in 31% of patients and increase in 12% of patients. Patients with increased MR after PCI had more severe inferior perfusion defects on baseline MPI (P=0.028), whereas defects in other distributions and LV volumes were similar (P=NS).
  
  
  CONCLUSIONS
  The extent and distribution of single-photon emission computed tomography-evidenced myocardial perfusion defects impact MR response to revascularization. An increased magnitude of inferior fixed perfusion defects predicts post-PCI progression of MR.
authors.affiliation: aDepartment of Medicine, Greenberg Cardiology Division, Weill Cornell Medical College, New York, New York Departments of bSurgery cBioengineering, University of California dVeterans Affairs Medical Center, San Francisco, California eDivision of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Parag
authors.initials: P
authors.lastname: Goyal
authors.forename: Jiwon
authors.initials: J
authors.lastname: Kim
authors.forename: Attila
authors.initials: A
authors.lastname: Feher
authors.forename: Claudia L
authors.initials: CL
authors.lastname: Ma
authors.forename: Sergey
authors.initials: S
authors.lastname: Gurevich
authors.forename: David R
authors.initials: DR
authors.lastname: Veal
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Szulc
authors.forename: Franklin J
authors.initials: FJ
authors.lastname: Wong
authors.forename: Mark B
authors.initials: MB
authors.lastname: Ratcliffe
authors.forename: Robert A
authors.initials: RA
authors.lastname: Levine
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055426:Cardiac-Gated Single-Photon Emission Computer-Assisted Tomography; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D055414:Myocardial Perfusion Imaging; D062645:Percutaneous Coronary Intervention; D018570:Risk Assessment; D013318:Stroke Volume