Abstract 12446: Impact of Infarct Location on Development of Ischemic Mitral Regurgitation in Patients With Acute Myocardial Infarction: Long-Term Echocardiographic Follow-Up Study
Background: It has been reported that patients with inferior myocardial infarction (MI) have higher incidence of ischemic mitral regurgitation (IMR) compared with patients with anterior MI. However, the impact of infarct location on development of IMR during long-term follow-up period has not been fully investigated.
Methods: We studied consecutive patients with acute MI from 2000 to 2006 who underwent emergent coronary angiography and were serially evaluated by transthoracic echocardiography during follow-up.
Results: The mean age of the 466 study patients was 65±10 years and 369 patients (79%) were men. Fifty-nine patients had recurrent MI, i.e. prior MI or second myocardial infarction during follow-up, and 43 patients had both anterior and infero-posterior MIs (Ant+IP-MI group). The remaining 423 patients had solely anterior (n=208; Ant-MI group) or infero-posterior MI (n=215; IP-MI group). The mean follow-up period was 7.0±3.2 years. Left ventricular remodeling during follow-up (end-diastolic volume change) was significantly larger in the Ant+IP-MI group, compared to the Ant-MI group and IP-MI group (22±30 ml vs. -0.7±30 ml vs. 0.01±25 ml, P≤0.001). The incidence of IMR (moderate or severe) was significantly higher in patients with Ant+IP-MI group, compared to patients with Ant-MI group and IP-MI group (16 [37%] vs. 13 [6%] vs. 18[8%], P≤0.001). The incidence of IMR was comparable between Ant-MI group and IP-MI group (P=0.40). Kaplan-Meier analysis revealed that patients with Ant+IP-MI group had significantly increased risk for cardiac death and heart failure, compared with patients with Ant-MI group and IP-MI group. Multivariate analysis revealed that combined anterior and infero-posterior infarct locations was the significant predictor of the development of IMR (p≤0.001).
Conclusions: Combined anterior and infero-posterior infarct locations, which was associated with left ventricular remodeling and adverse cardiac events, was an independent predictor of IMR development in patients after acute MI.
- © 2013 by American Heart Association, Inc.