Published online before print January 17, 2005, doi: 10.1161/01.CIR.0000151097.30779.04
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(Circulation. 2005;111:295-301.)
© 2005 American Heart Association, Inc.
Heart Failure |
Heart Failure and Death After Myocardial Infarction in the Community
The Emerging Role of Mitral Regurgitation
From the Division of Cardiovascular Diseases, Department of Internal Medicine (F.B., M.E.-S., V.T.N., V.L.R.) and Department of Health Sciences Research (S.J.J., S.A.W., R.A.M., V.L.R.), Mayo Clinic and Foundation, Rochester, Minn.
Correspondence to Véronique L. Roger, MD, MPH, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail roger.veronique{at}mayo.edu
Received June 17, 2004; revision received October 7, 2004; accepted October 15, 2004.
Background— In case series, mitral regurgitation (MR) increased the risk of death after myocardial infarction (MI), yet the prevalence of MR, its incremental prognostic value over ejection fraction (EF), and its association with heart failure and death after MI in the community is not known.
Methods and Results— The prevalence of MR and its association with heart failure and death were examined among 1331 patients within a geographically defined MI incidence cohort between 1988 and 1998. Echocardiography was performed within 30 days after MI in 773 patients (58%), and MR was present in 50% of cases, mild in 38%, and moderate or severe in 12%. Among patients with MR, a murmur was inconsistently detected clinically. After 4.7±3.3 years of follow-up, 109 episodes of heart failure and 335 deaths occurred. There was a graded positive association between the presence and severity of MR and heart failure or death. Moderate or severe MR was associated with a large increase in the risk of heart failure (relative risk 3.44, 95% CI 1.74 to 6.82, P<0.001) and death (relative risk 1.55, 95% CI 1.08 to 2.22, P=0.019) among 30-day survivors independent of age, gender, EF, and Killip class.
Conclusions— In the community, MR is frequent and often silent after MI. It carries information to predict heart failure or death among 30-day survivors independently of age, gender, EF, and Killip class. These findings, which are applicable to a large community-based MI cohort, suggest that the assessment of MR should be included in post-MI risk stratification.
Key Words: mitral valve • regurgitation • myocardial infarction • prognosis • population
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