Serial Echocardiographic Changes in Left Ventricular Remodeling and Ischemic Mitral Regurgitation During Medical Therapy and After Coronary Revascularization: A Contemporary Cohort Study.

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 cm2 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.