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European Heart Journal Advance Access originally published online on October 30, 2007
European Heart Journal 2007 28(23):2866-2872; doi:10.1093/eurheartj/ehm469
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome: contribution to congestive heart failure

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

Unidad de Imagen Cardiovascular, Instituto Cardiovascular, Hospital Clínico San Carlos, Plaza Cristo Rey, 28040 Madrid, Spain

Received 28 May 2007; revised 15 September 2007; accepted 24 September 2007; online publish-ahead-of-print 30 October 2007.

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

Aims: Functional mitral regurgitation (MR) is a frequent complication after the acute phase of a myocardial infarction and plays an important role in the development of congestive heart failure (CHF) after a Q-wave myocardial infarction. Nevertheless, until now, the relevance of functional MR after a non-ST-segment elevation acute coronary syndrome (NSTSEACS) has been poorly addressed. Our aim was to assess the relationship between the presence or absence and the severity of functional MR after a first NSTSEACS and the development of CHF.

Methods and results: Two hundred and seventy-nine patients discharged from hospital in NYHA functional classes I and II (71.7% men; mean age 66.3 ± 13.2 years) after a first NSTSEACS were studied. Every patient underwent an echocardiographic study during the first week after the index NSTSEACS and were clinically followed-up. MR was detected in 40.1% patients. Patients were followed-up for a median time of 418 days (inter-quartile range: 295–561). Six patients (3.6%) in the group without MR and 15 patients (13.4%) in the group with MR required hospitalization due to CHF during follow-up. Only MR was found as an independent predictor of CHF development (HR = 1.8; 95% CI = 1.1–3.1; P = 0.02) and CHF development or cardiac death (HR = 2.1; 95% CI = 1.3–3.3; P = 0.01) in the long-term follow-up multivariable Cox regression analysis.

Conclusion: There is an increased risk for subsequent CHF in patients with MR after a first NSTSEACS. The risk of CHF is closely related to the MR presence and severity. Thus, the detection of MR by means of Doppler echocardiography after a first episode of NSTSEACS is crucial.

Key Words: Mitral regurgitation • Non-ST-segment elevation acute coronary syndrome • Congestive heart failure


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