Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction

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Abstract

Mitral regurgitation (MR) complicating acute myocardial infarction (AMI) is associated with increased mortality. The prognostic significance of only mild MR detected by echocardiography in patients with AMI is unknown. This study assessed the long-term risk associated with mild MR detected by color Doppler echocardiography within the first 48 hours of admission in 417 consecutive patients with AMI. No MR was detected in 271 patients (65%), mild MR was seen in 121 patients (29%), and moderate or severe MR was noted in 25 patients (6%). One-year mortality rates were 4.8%, 12.4%, and 24%, respectively (p <0.001). Multivariate analysis revealed that mild MR was independently associated with increased 1-year mortality (p <0.05) after adjustment for age, gender, previous myocardial infarction, diabetes mellitus, systemic hypertension, Killip grade ≥2 on admission, and left ventricular ejection fraction ≤40%. The hazard ratio for 1-year mortality was 2.31 (95% confidence interval 1.03 to 5.20) for mild MR and 2.85 (95% confidence interval 0.95 to 8.51) for moderate or severe MR. Thus, mild MR detected by color Doppler echocardiography within the first 2 days of admission in patients with AMI is a significant independent risk predictor for 1-year all-cause mortality.

Section snippets

Study population

During 1996, 451 consecutive patients with documented AMI were admitted to the coronary care unit of the Heart Institute of Chaim Sheba Medical Center and Rabin Medical Center. Myocardial infarction was detected by the presence of at least 2 of the following criteria: chest pain lasting >30 minutes, typical electrocardiographic changes, and elevated creatinine kinase-MB fraction. Myocardial infarction location was determined by electrocardiographic criteria.9 Twelve patients died shortly after

Incidence of MR early after AMI

MR was not detected by color Doppler echocardiography in 271 of the 417 patients with AMI (65%). Mild MR was present in 121 patients (29%), moderate MR in 21 (5%), and severe MR in 4 (1%). Moderate and severe MR groups were grouped together because of their small numbers. Only 1 patient had ruptured chorda with flail mitral valve and severe regurgitation.

Clinical characteristics (Table 1)

Patients with MR were older (p <0.001) and more likely to have a history of myocardial infarction (p = 0.001) and hypertension (p = 0.03)

Discussion

The present study prospectively demonstrates in a large consecutive group of patients with AMI that mild MR is an independent risk factor for 1-year mortality. Color Doppler echocardiography was performed using an algorithm that reflects current clinical practice: it was not only based on assessment of regurgitation jet area within the atrium,10 but it also considered fluid dynamic lessons about the behavior of regurgitation jets, particularly jet eccentricity,12 and included qualitative

Acknowledgements

We thank Shula Imbar, Patricia Benjamin, Lily Ezer, Ziva Saidov and Vitali Osmanov for their assistance in performing the studies.

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