(Circulation. 1997;96:827-833.)
© 1997 American Heart Association, Inc.
Articles |
Clinical Significance of Mitral Regurgitation After Acute Myocardial Infarction
From the Division of Cardiology, Mount Sinai Medical Center, Miami Beach, and the University of Miami School of Medicine, Miami, Fla (G.A.L.); Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (G.F.M., E.B., M.A.P.); the University of Missouri Hospitals and Medical School, Columbia (G.C.F.); the University of North Carolina School of Medicine, Chapel Hill (S.C.S.); Georgetown University Hospital and Medical School, Washington, DC (B.J.G.); the University of South Florida School of Medicine, Tampa (L.B.); and the University of Texas Health Sciences Center, Houston (L.M.).
Background Mitral regurgitation (MR) may complicate acute myocardial infarction (MI). However, it is not known whether mild MR is an independent predictor of post-MI outcome.
Methods and Results The study cohort consisted of 727 Survival and Ventricular Enlargement Study patients who underwent cardiac catheterization, including left ventriculography, up to 16 days after MI. Left ventriculograms were analyzed for diastolic and systolic volumes, global left ventricular sphericity, extent of wall motion abnormality, and endocardial curvature. The presence of MR was related to the risk of developing a cardiovascular event during 3.5 years of follow-up. MR was present in 141 patients (19.4%). Severe (3+) MR was present in only 2 patients. Patients with MR were more likely to have a persistently occluded infarct artery (MR versus no MR, 27.3% versus 15.2%; P=.001). Although the ejection fractions were similar, MR patients had larger end-systolic and end-diastolic volumes and more spherical ventricles than patients without MR. Sphericity change from diastole to systole was also significantly reduced in MR patients. Patients with MR were more likely to experience cardiovascular mortality (29% versus 12%; P<.001), severe heart failure (24% versus 16%; P=.0153), and the combined end point of cardiovascular mortality, severe heart failure, or recurrent myocardial infarction (47% versus 29%; P<.001). The presence of MR was an independent predictor of cardiovascular mortality (relative risk, 2.00; 95% CI, 1.28 to 3.04).
Conclusions Mild MR is an independent predictor of post-MI mortality. As such, it adds important information for risk stratification of post-MI patients.
Key Words: mitral valve • heart failure • myocardial infarction • ventricles
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Is a good perioperative echocardiographic result predictive of durability in ischemic mitral valve repair? J. Thorac. Cardiovasc. Surg., March 1, 2006; 131(3): 565 - 573.e2.
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M. A. Borger, A. Alam, P. M. Murphy, T. Doenst, and T. E. David Chronic Ischemic Mitral Regurgitation: Repair, Replace or Rethink? Ann. Thorac. Surg., March 1, 2006; 81(3): 1153 - 1161. [Abstract] [Full Text] [PDF]
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J. G. Webb, J. Harnek, B. I. Munt, P. O. Kimblad, M. Chandavimol, C. R. Thompson, J. R. Mayo, and J. O. Solem Percutaneous Transvenous Mitral Annuloplasty: Initial Human Experience With Device Implantation in the Coronary Sinus Circulation, February 14, 2006; 113(6): 851 - 855. [Abstract] [Full Text] [PDF]
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J. N. Schroder, M. L. Williams, J. A. Hata, L. H. Muhlbaier, M. Swaminathan, J. P. Mathew, D. D. Glower, C. M. O'Connor, P. K. Smith, and C. A. Milano Impact of Mitral Valve Regurgitation Evaluated by Intraoperative Transesophageal Echocardiography on Long-Term Outcomes After Coronary Artery Bypass Grafting Circulation, August 30, 2005; 112(9_suppl): I-293 - I-298. [Abstract] [Full Text] [PDF]
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R. A. Levine and E. Schwammenthal Ischemic Mitral Regurgitation on the Threshold of a Solution: From Paradoxes to Unifying Concepts Circulation, August 2, 2005; 112(5): 745 - 758. [Full Text] [PDF]
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D. R. Wong, A. K. Agnihotri, J. W. Hung, G. J. Vlahakes, C. W. Akins, A. D. Hilgenberg, J. C. Madsen, T. E. MacGillivray, M. H. Picard, and D. F. Torchiana Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation Ann. Thorac. Surg., August 1, 2005; 80(2): 570 - 577. [Abstract] [Full Text] [PDF]
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P. Lancellotti, P. L. Gerard, and L. A. Pierard Long-term outcome of patients with heart failure and dynamic functional mitral regurgitation Eur. Heart J., August 1, 2005; 26(15): 1528 - 1532. [Abstract] [Full Text] [PDF]
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T. Uemura, Y. Otsuji, K. Nakashiki, S. Yoshifuku, Y. Maki, B. Yu, N. Mizukami, E. Kuwahara, S. Hamasaki, S. Biro, et al. Papillary Muscle Dysfunction Attenuates Ischemic Mitral Regurgitation in Patients With Localized Basal Inferior Left Ventricular Remodeling: Insights From Tissue Doppler Strain Imaging J. Am. Coll. Cardiol., July 5, 2005; 46(1): 113 - 119. [Abstract] [Full Text] [PDF]
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M. B. Srichai, R. A. Grimm, A. E. Stillman, A. M. Gillinov, L. L. Rodriguez, M. L. Lieber, A. Lara, J. A. Weaver, P. M. McCarthy, and R. D. White Ischemic Mitral Regurgitation: Impact of the Left Ventricle and Mitral Valve in Patients with Left Ventricular Systolic Dysfunction Ann. Thorac. Surg., July 1, 2005; 80(1): 170 - 178. [Abstract] [Full Text] [PDF]
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M. Daimon, T. Shiota, A. M. Gillinov, M. Hayase, M. Ruel, W. E. Cohn, S. J. Blacker, and J. R. Liddicoat Percutaneous Mitral Valve Repair for Chronic Ischemic Mitral Regurgitation: A Real-Time Three-Dimensional Echocardiographic Study in an Ovine Model Circulation, May 3, 2005; 111(17): 2183 - 2189. [Abstract] [Full Text] [PDF]
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J. Braun, J. J. Bax, M. I.M. Versteegh, P. G. Voigt, E. R. Holman, R. J.M. Klautz, E. Boersma, and R. A.E. Dion Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation Eur. J. Cardiothorac. Surg., May 1, 2005; 27(5): 847 - 853. [Abstract] [Full Text] [PDF]
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P. A. Grayburn, C. P. Appleton, A. N. DeMaria, B. Greenberg, B. Lowes, J. Oh, J. F. Plehn, P. Rahko, M. St. John Sutton, E. J. Eichhorn, et al. Echocardiographic predictors of morbidity and mortality in patients with advanced heart failure: The Beta-blocker Evaluation of Survival Trial (BEST) J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1064 - 1071. [Abstract] [Full Text] [PDF]
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N. Watanabe, Y. Ogasawara, Y. Yamaura, T. Kawamoto, E. Toyota, T. Akasaka, and K. Yoshida Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography J. Am. Coll. Cardiol., March 1, 2005; 45(5): 763 - 769. [Abstract] [Full Text] [PDF]
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J. Zamorano, L. P. de Isla, L. Oliveros, C. Almeria, J. L. Rodrigo, A. Aubele, J. Banchs, and C. Macaya Prognostic influence of mitral regurgitation prior to a first myocardial infarction Eur. Heart J., February 2, 2005; 26(4): 343 - 349. [Abstract] [Full Text] [PDF]
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R. Ramadan, N. Al-Attar, S. Mohammadi, S. Ghostine, A. Azmoun, A. Therasse, C. Kortas, C. Caussin, and R. Nottin Left ventricular infarct plication restores mitral function in chronic ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., February 1, 2005; 129(2): 440 - 442. [Full Text] [PDF]
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T. V. Salukhe, M. Y. Henein, and R. Sutton Ischemic Mitral Regurgitation and Its Related Risk After Myocardial Infarction Circulation, January 25, 2005; 111(3): 254 - 256. [Full Text] [PDF]
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F. Bursi, M. Enriquez-Sarano, V. T. Nkomo, S. J. Jacobsen, S. A. Weston, R. A. Meverden, and V. L. Roger Heart Failure and Death After Myocardial Infarction in the Community: The Emerging Role of Mitral Regurgitation Circulation, January 25, 2005; 111(3): 295 - 301. [Abstract] [Full Text] [PDF]
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F. Grigioni, D. Detaint, J.-F. Avierinos, C. Scott, J. Tajik, and M. Enriquez-Sarano Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction J. Am. Coll. Cardiol., January 18, 2005; 45(2): 260 - 267. [Abstract] [Full Text] [PDF]
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M. J. Byrne, D. M. Kaye, M. Mathis, D. G. Reuter, C. A. Alferness, and J. M. Power Percutaneous Mitral Annular Reduction Provides Continued Benefit in an Ovine Model of Dilated Cardiomyopathy Circulation, November 9, 2004; 110(19): 3088 - 3092. [Abstract] [Full Text] [PDF]
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C. V. Maniu, J. B. Patel, D. G. Reuter, D. M. Meyer, W. D. Edwards, C. S. Rihal, and M. M. Redfield Acute and chronic reduction of functional mitral regurgitation in experimental heart failure by percutaneous mitral annuloplasty J. Am. Coll. Cardiol., October 19, 2004; 44(8): 1652 - 1661. [Abstract] [Full Text] [PDF]
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E. Agricola, M. Oppizzi, F. Maisano, M. De Bonis, A. F.L. Schinkel, L. Torracca, A. Margonato, G. Melisurgo, and O. Alfieri Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern Eur J Echocardiogr, October 1, 2004; 5(5): 326 - 334. [Abstract] [Full Text] [PDF]
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M. D. Diodato, M. R. Moon, M. K. Pasque, H. B. Barner, N. Moazami, J. S. Lawton, M. S. Bailey, T. J. Guthrie, B. F. Meyers, and R. J. Damiano Jr Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: A propensity analysis Ann. Thorac. Surg., September 1, 2004; 78(3): 794 - 799. [Abstract] [Full Text] [PDF]
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A. M. Calafiore, M. Di Mauro, S. Gallina, G. Di Giammarco, A. L. Iaco, G. Teodori, and I. Tavarozzi Mitral valve surgery for chronic ischemic mitral regurgitation Ann. Thorac. Surg., June 1, 2004; 77(6): 1989 - 1997. [Abstract] [Full Text] [PDF]
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G. G. Pellizzon, C. L. Grines, D. A. Cox, T. Stuckey, J. E. Tcheng, E. Garcia, G. Guagliumi, M. Turco, A. J. Lansky, J. J. Griffin, et al. Importance of mitral regurgitation inpatients undergoing percutaneous coronaryintervention for acute myocardial infarction: The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Trial J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1368 - 1374. [Abstract] [Full Text] [PDF]
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M. H. Yacoub and L. H. Cohn Novel Approaches to Cardiac Valve Repair: From Structure to Function: Part II Circulation, March 9, 2004; 109(9): 1064 - 1072. [Full Text] [PDF]
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H. R. Mallidi, M. P. Pelletier, J. Lamb, N. Desai, J. Sever, G. T. Christakis, G. Cohen, B. S. Goldman, and S. E. Fremes Late outcomes in patients with uncorrected mild to moderate mitral regurgitation at the time of isolated coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., March 1, 2004; 127(3): 636 - 644. [Abstract] [Full Text] [PDF]
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T. S. Guy IV, S. L. Moainie, J. H. Gorman III, B. M. Jackson, T. Plappert, Y. Enomoto, M. G. St. John-Sutton, L. H. Edmunds Jr, and R. C. Gorman Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction J. Am. Coll. Cardiol., February 4, 2004; 43(3): 377 - 383. [Abstract] [Full Text] [PDF]
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