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European Heart Journal Advance Access originally published online on October 2, 2006
European Heart Journal 2006 27(22):2655-2660; doi:10.1093/eurheartj/ehl287
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome

Leopoldo Perez de Isla, Jose Zamorano*, Maribel Quezada, Carlos Almería, José Luis Rodrigo, Viviana Serra, Juan Carlos García Rubira, Antonio Fernandez Ortiz and Carlos Macaya

Instituto Cardiovascular, Echocardiographic Laboratory, Hospital Clínico San Carlos, Plaza Cristo Rey, 28040 Madrid, Spain

Received 11 May 2006; revised 1 September 2006; accepted 14 September 2006; online publish-ahead-of-print 2 October 2006.

* Corresponding author. Tel: +34 913303290; fax: +34 913303290. E-mail address: jlzamorano{at}vodafone.es

See page 2615 for the editorial comment on this article (doi:10.1093/eurheartj/ehl320)

Aims The development of mitral regurgitation (MR) after an acute myocardial infarction (AMI) is a recognized and frequent complication and its negative impact on survival has been observed. However, few data exist regarding MR after non-ST-segment elevation acute coronary syndrome (NSTSEACS). Our aim was to investigate the incidence, clinical predictors, and prognostic implications of MR in the setting of NSTSEACS.

Methods and results We studied 300 consecutive patients (71.7% men, mean age 66.9±13 years) admitted to our coronary care unit for an NSTSEACS. Every patient underwent an echocardiographic study during the first week after the index NSTSEACS and was clinically followed up. MR was detected in 42% (126 patients; 88 men, mean age 71.3±11 years). Mean follow-up was 425.6±194.8 days. Only age and left ventricular (LV) ejection fraction (EF) were found as independent markers of the development of MR; no variable was found as an independent predictor of in-hospital mortality and only MR was found as an independent predictor of long-term outcome.

Conclusion MR is frequent after an NSTSEACS. Age and a low LV EF are factors associated to its development. The presence and degree of MR confer a worse long-term prognosis to patients after a first NSTSEACS. Thus, the presence of MR should be specifically assessed in every patient after an NSTSEACS.

Key Words: Myocardial infarction • Mitral regurgitation • Prognosis • Non-ST-segment elevation acute coronary syndrome


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