Elsevier

American Heart Journal

Volume 150, Issue 6, December 2005, Pages 1268-1275
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Prognostic significance of echocardiographically defined mitral regurgitation early after acute myocardial infarction

https://doi.org/10.1016/j.ahj.2005.01.020Get rights and content

Background

There are limited data regarding the clinical correlates and prognostic significance of echocardiographically defined mitral regurgitation (MR) early after acute myocardial infarction (MI). The current study addressed these issues.

Methods

Seven hundred thirty-seven patients with acute MI who underwent transthoracic echocardiography with assessment of MR during their index admission were identified. Patients were followed up a median of 19 months later. The study end point was all-cause mortality.

Results

The prevalence of MR increased with age. It was more common in women, in patients with non–ST-elevation MI, and in those with a history of diabetes, hypertension, prior MI, or previous revascularization. Patients with MR had worse left ventricular (LV) systolic function, more LV dilatation, and more clinical evidence of LV failure. Patients with moderate or severe MR had worse survival than those with no or mild MR (hazard ratio 2.3, 95% CI 1.6-3.2, P < .0001). Even mild MR predicted a higher mortality when compared with no MR (hazard ratio 1.7, 95% CI 1.2-2.4, P = .004). Mild or moderate MR was not independently predictive of outcome, although, in multivariable analyses, a trend toward worse survival was maintained in patients with severe MR.

Conclusions

Mitral regurgitation, identified by echocardiography, early after acute MI predicts poorer survival after acute MI. However, if mild or moderate, it is not an independent prognostic indicator.

Section snippets

Patients

Between January 1999 and July 2001, 793 patients admitted to St Mary's Hospital (Rochester, MN) with acute MI had a clinically indicated transthoracic echocardiogram during their index admission. The severity of MR could be accurately assessed in 737 (93%) patients. These patients formed the study cohort. Myocardial infarction was defined using the European Society of Cardiology/American College of Cardiology guidelines.7 The study complies with the Declaration of Helsinki and was approved by

Results

The characteristics of the study cohort are shown in Table I. Echocardiograms were performed a median of 1 (interquartile range 0-2) day after admission. No/trivial MR was detected in 320 (43%) patients; mild MR (grade 1), in 320 (43%); moderate MR (grade 2), in 78 (11%); and severe MR (grade 3), in 19 (3%). There were no cases of papillary muscle rupture.

Among the 97 patients with moderate or severe MR (≥grade 2), 40 (41%) had an ischemic etiology. In 21 (22%) cases, MR was caused by

Discussion

The present study confirms that, in a large cohort of patients undergoing transthoracic echocardiography after acute MI, defined using contemporary criteria, MR is frequently identified by color Doppler echocardiography. The presence of MR predicts increased mortality after acute MI. However, if mild or moderate, it is not an independent prognostic indicator.

References (23)

  • K.G. Lehmann et al.

    Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group

    Ann Intern Med

    (1992)
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    Dr Graham S. Hillis was supported by the British Heart Foundation; Dr Jacob E. Møller, by the Danish Heart Foundation.

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