Wall Motion Score Index Predicts Persistent Moderate or Severe Secondary Mitral Regurgitation and its Prognostic Role in Patients Undergoing Percutaneous Coronary Intervention

TL;DR

This study finds that a heart function measure called WMSI can predict ongoing heart issues in patients with a specific heart condition after a common heart procedure.

Contribution

The study demonstrates that elevated wall motion score index after PCI is a novel independent predictor of persistent secondary mitral regurgitation and adverse outcomes.

Findings

Persistent moderate or severe secondary mitral regurgitation occurred in 39.8% of patients after PCI.

Elevated WMSI after PCI independently predicted persistent sMR and increased risks of heart failure and mortality.

WMSI was associated with major adverse cardiovascular events and all-cause mortality in adjusted models.

Abstract

Patients with secondary mitral regurgitation (sMR) often
present with greater mortality and comorbidity, which may be predicted by some
risk factors. This study was designed to investigate the prognostic meaning of
the echocardiographically detected wall motion score index (WMSI) in coronary
artery disease (CAD) patients with moderate or severe baseline sMR who underwent
percutaneous coronary intervention (PCI) therapy.

The present
study was a multi-center and prospective cohort of consecutive CAD patients with
baseline moderate or severe sMR who underwent PCI. All underwent echocardiography
at baseline and at follow-up after PCI to assess sMR and WMSI. The primary
endpoint was the persistence of moderate or severe sMR after the second
echocardiographic measurement. Logistic and Cox proportional hazards models were
constructed for the primary (persistent moderate or severe sMR) and secondary
(worsening heart failure [HF]; all-cause mortality; cardiovascular-specific
mortality; and major adverse cardiovascular events [MACE]) endpoints.

Among 920 participants, 483 had WMSI values of ≥1.47,
and 437 were less. Of all the participants, 366 (39.8%) continued to have
moderate or severe sMR after the second echocardiogram measurement. After full
adjustment for confounders, elevated WMSI after PCI was independently associated
with the primary endpoint during 3–12 month follow-up. Similarly, elevated WMSI
was associated with increased risk of worsening HF, all-cause mortality,
cardiovascular-specific mortality, and MACE.

Persistent
moderate or severe sMR is common (approximately 40%) in PCI patients. Elevated
WMSI in CAD patients after PCI is a predictor of persistent moderate or severe
sMR and has independent negative prognostic value. Patients with CAD and sMR
should be monitored for WMSI to identify those at higher risk of mortality and
comorbidity.

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