The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease.

To evaluate the significance of mitral regurgitation in coronary artery disease (CAD), clinical, electrocardiographic, and angiographic data in 100 coronary artery disease patients with mitral regurgitation were compared to data in 100 coronary artery disease patients without mitral regurgitation. Mitral regurgitation was mild (1+) to moderate (2+) in 94 patients. Heart failure, cardiomegaly, and anterior myocardial infarction were more common in mitral regurgitation patients than in controls (33 vs 4;47 vs 8;22 vs 5, respectively, P < 0.001). The frequency of inferior myocardial infarction was equal in both groups. Significant left anterior descending and circumflex disease was equally frequent; however, right coronary disease was more frequent in patients with mitral regurgitation (87 vs 68, P < 0.001). Total vessel occlusions and triple-vessel disease were more frequent in patients with mitral regurgitation (113 vs 78, P < 0.01; 60 vs 40, P < 0.001, respectively). No localized area of asynergy was more common in patients or controls,, but left ventricular aneurysms and generalized hypokinesis were more common in patients with mitral regurgitation (6 vs 0; 23 vs 2; P < 0.001). These data suggest that mitral regurgitation is most often mild, but is associated with significant left ventricular dysfunction and advanced CAD.