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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
- Source :
- European Heart Journal. 28:326-333
- Publication Year :
- 2007
- Publisher :
- Oxford University Press (OUP), 2007.
-
Abstract
- 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.
- Subjects :
- Male
medicine.medical_specialty
Cardiac Volume
Myocardial Infarction
Diastole
Electrocardiography
Ventricular Dysfunction, Left
Risk Factors
Internal medicine
Mitral valve
medicine
Humans
Prospective Studies
Myocardial infarction
Systole
Ventricular remodeling
Aged
Randomized Controlled Trials as Topic
Heart Failure
Observer Variation
Mitral regurgitation
Ejection fraction
Ventricular Remodeling
business.industry
Mitral Valve Insufficiency
Middle Aged
Prognosis
medicine.disease
Echocardiography, Doppler, Color
medicine.anatomical_structure
Heart failure
Disease Progression
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15229645 and 0195668X
- Volume :
- 28
- Database :
- OpenAIRE
- Journal :
- European Heart Journal
- Accession number :
- edsair.doi.dedup.....a93a7082a87ce84f89d9e9902f3a1679