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