(Circulation. 2001;103:1759.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Ischemic Mitral Regurgitation
Long-Term Outcome and Prognostic Implications With Quantitative Doppler Assessment
From the Division of Cardiovascular Diseases and Internal Medicine (F.G., M.E.-S., A.J.T.), the Division of Cardiovascular Surgery (K.J.Z.), and the Section of Biostatistics (K.R.B.), Mayo Clinic, Rochester, Minn.
Background—Myocardial infarction (MI) can directly cause ischemic mitral regurgitation (IMR), which has been touted as an indicator of poor prognosis in acute and early phases after MI. However, in the chronic post-MI phase, prognostic implications of IMR presence and degree are poorly defined.
Methods and Results—We
analyzed 303 patients with previous (>16 days) Q-wave MI by ECG who
underwent transthoracic echocardiography: 194 with IMR quantitatively
assessed in routine practice and 109 without IMR matched for baseline
age (71±11 versus 70±9 years,
P=0.20), sex, and ejection
fraction (EF, 33±14% versus 34±11%,
P=0.14). In IMR patients,
regurgitant volume (RVol) and effective regurgitant orifice (ERO) area
were 36±24 mL/beat and 21±12 mm2,
respectively. After 5 years, total mortality and cardiac mortality for
patients with IMR (62±5% and 50±6%, respectively) were higher than
for those without IMR (39±6% and 30±5%, respectively) (both
P<0.001). In multivariate
analysis, independently of all baseline characteristics, particularly
age and EF, the adjusted relative risks of total and cardiac mortality
associated with the presence of IMR (1.88,
P=0.003 and 1.83,
P=0.014, respectively) and
quantified degree of IMR defined by RVol 
30 mL (2.05,
P=0.002 and 2.01,
P=0.009) and by ERO 20
mm2 (2.23,
P=0.003 and 2.38,
P=0.004) were
high.
Conclusions—In the chronic phase after MI, IMR presence is associated with excess mortality independently of baseline characteristics and degree of ventricular dysfunction. The mortality risk is related directly to the degree of IMR as defined by ERO and RVol. Therefore, IMR detection and quantification provide major information for risk stratification and clinical decision making in the chronic post-MI phase.
Key Words: infarction • mitral valve • prognosis • regurgitation
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