Serial Echocardiographic Changes in Left Ventricular Remodeling and Ischemic Mitral Regurgitation During Medical Therapy and After Coronary Revascularization: A Contemporary Cohort Study
Jamilah AlRahimi, Rawan Asiri, Sarah Albogami, Laila Assiri, Yasser IsmailABSTRACT
Background
Ischemic mitral regurgitation (IMR) reflects left ventricular (LV) remodeling, but its within‐patient trajectory during sequential medical therapy and coronary revascularization remains incompletely characterized.
Objectives
To compare within‐patient changes in LV remodeling and IMR severity during the medical‐therapy and subsequent post‐revascularization intervals and examine the association between LV reverse remodeling and IMR regression.
Methods
In this single‐center retrospective complete‐case serial‐imaging cohort, 125 adults with significant IMR underwent quantitative echocardiography at baseline, after medical therapy, and 2–3 months after PCI or CABG. The primary endpoint was ≥1‐grade IMR improvement from baseline to final follow‐up. Patient‐level changes during the medical‐therapy and subsequent post‐revascularization intervals were compared using Wilcoxon signed‐rank tests with Holm adjustment.
Results
Median LVEDV reduction was 3 mL (IQR −4 to 19) during the medical‐therapy interval versus 22 mL (IQR 5–51) during the post‐revascularization interval. Corresponding improvements were 1 versus 8 percentage points for LVEF, 0.02 versus 0.16 cm 2 for EROA, and 2 versus 21 mL/beat for regurgitant volume (Holm‐adjusted p < 0.001 for all comparisons). Overall, 93 patients (74.4%) achieved ≥1‐grade IMR improvement. LV reverse remodeling occurred in 80 (64.0%) and was strongly associated with IMR improvement. Excluding 25 patients with >50% LVEDV reduction yielded consistent findings.
Conclusions
Serial echocardiography demonstrated substantially greater ventricular and IMR improvement during the post‐revascularization interval than during the preceding medical‐therapy interval. These temporal associations do not establish an independent causal effect of revascularization but support serial echocardiographic assessment of ventricular remodeling and residual IMR.