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European Heart Journal Advance Access published online on October 2, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl287
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received May 11, 2006
Revised September 1, 2006
Accepted September 14, 2006

Clinical research

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

Leopoldo Perez de Isla 1, Jose Zamorano 1 *, Maribel Quezada 1, Carlos Almería 1, José Luis Rodrigo 1, Viviana Serra 1, Juan Carlos Garcia Rubira 1, Antonio Fernandez Ortiz 1, and Carlos Macaya 1

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

* To whom correspondence should be addressed.
Jose Zamorano, E-mail: jlzamorano{at}vodafone.es


  Abstract

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.

Keywords: Myocardial infarction; Mitral regurgitation; Prognosis; Non-ST-segment elevation acute coronary syndrome.
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