European Heart Journal Advance Access originally published online on January 24, 2007
European Heart Journal 2007 28(3):326-333; doi:10.1093/eurheartj/ehl464
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Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function
1 Brigham and Women's Hospital, Boston, Massachusetts, USA
2 Foothills Hospital, Calgary, Canada
3 Central Hospital in Rogaland, Stavanger, Norway
4 London Health Sciences Center-Victoria Campus, East London, Canada
5 Duke University Medical Center, Durham, North Carolina, USA
6 Leuven Coordinating Center, Leuven, Belgium
7 Cardiac Centers of Louisiana, Shreveport, Louisiana, USA
8 Western Infirmary, Glasgow, Scotland
9 University of Copenhagen Rigshospitalet, Copenhagen, Denmark
Received 22 April 2006; revised 24 October 2006; accepted 14 December 2006; online publish-ahead-of-print 24 January 2007.
* Corresponding author. Tel: +39 328 4090281. E-mail address: maria_amigoni{at}libero.it
Aims Mitral regurgitation (MR) confers independent risk in patients with acute myocardial infarction. We utilized data from the VALsartan In Acute myocardial iNfarcTion echo study to relate baseline MR to left ventricular (LV) size, shape, and function, and to assess the relationship between baseline MR and progression of MR and cardiovascular (CV) outcomes.
Methods and results We studied 496 patients with heart failure (HF) and/or systolic dysfunction after MI who underwent echocardiography at a median of 5 days after MI. MR severity, quantified as the regurgitant jet area/left atrial area ratio, was assessed at baseline, one and 20 months post-MI and related to LV size, shape, function, and clinical outcomes. Increased MR at baseline was associated with larger LV end-diastolic and end-systolic volumes, increased sphericity index, and reduced ejection fraction (P trend < 0.001). Moderate–severe MR was an independent predictor of total mortality [adjusted hazard ratio (HR) 2.4 (1.1–5.3)], CV mortality [adjusted HR 2.7 (1.2–6.1)], hospitalization for HF [adjusted HR 2.5 (1.1–5.5)], or death or HF hospitalization [adjusted HR 2.5 (1.4–4.6)]. Patients with progression of MR during the first post-MI month were substantially more likely to die or develop HF (adjusted HR per increased MR grade 3.0, 95% CI 1.8–4.9). Progression of MR over 20 months in survivors was associated with increased hospitalizations for HF (P < 0.001).
Conclusion Following high-risk myocardial infarction, baseline mitral regurgitant severity is associated with larger LV volumes and worse LV function. Both baseline MR severity and progression of MR are associated with an increased likelihood of adverse outcomes.
Key Words: VALsartan In Acute myocardial iNfarcTion • Echocardiography • Mitral regurgitation • Left ventricular shape and function • Prognosis
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