Abstract 3373: Determinants of Progression of Mitral Regurgitation During Long-Term Follow-Up After Myocardial Infarction: The VALIANT Echo Study
Introduction. Mitral regurgitation (MR) is an important predictor of adverse cardiovascular outcome following myocardial infarction (MI). We sought to study the determinants of progression of MR after MI.
Methods. The VALsartan In Acute myocardial iNfarcTion (VALIANT) echo study prospectively enrolled 603 patients with left ventricular (LV) dysfunction, heart failure (HF), or both following MI (mean 4.9 days). We quantified baseline and 20-months MR by measuring the ratio of jet regurgitant area to left atrial area in 341 patients with good quality echocardiograms, and without intrinsic valvular disease who survived to complete the follow-up. At baseline, we measured indices of mitral geometry and local and global LV remodeling, including tenting area, coaptation depth, mitral annular diameter and contraction, distance between the head of posterior papillary muscle (PPM) and the intervalvular fibrosa, concavity of anterior mitral leaflet, akinesia and thinning or bulging of inferior wall, LV ejection fraction, volumes, and sphericity index.
Results. MR degree increased by 1 grade or more in 88 patients (26%) and decreased by 1 grade or more in 51 patients (15%). In multivariate analysis, mitral tenting area - the area enclosed between the annular plane and mitral leaflet and an index of mitral geometry - was the most important predictor of change in MR between baseline and 20 months (P=0.004). The extent of MR change was not related to LV ejection fraction or measures of global LV remodeling (Table⇓). Tenting area correlated significantly with the other indices of local and global remodeling, in particular with PPM-intervalvular fibrosa distance, annular diameter, and LV end-systolic volume
Conclusions. While ventricular remodeling contributes to progression of MR after MI, this influence is dependent on alterations in mitral geometry. Mitral geometry and quartiles of MR changes during 20 months