Mitral regurgitation during a myocardial infarction – New predictors and prognostic significance at two years of follow-up

Barra, Sérgio; Providência, Rui; Paiva, Luís; Gomes, Pedro; Seca, Luís; Silva, Joana; Nascimento, Janaína Santos; Leitão‐Marques, António

doi:10.3109/17482941.2012.655295

Cited by 9 publications

(17 citation statements)

References 17 publications

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“…This disparity is explained by the different methods utilized for assessing IMR, the heterogeneity of studied populations, and different reperfusion utilized techniques [1-18]. In addition, some of this data is based on secondary analysis of clinical trials [1,9,10,12,13], which are subject to referral and selection biases, while others assessed and quantified the severity of IMR in the subacute time period [2-6,16,17]. Finally, of these studies, only a minority was based on modern primary PCI strategy [3,9,15,18].…”

Section: Introductionmentioning

confidence: 99%

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

MacHaalany

Bertrand

O’Connor

et al. 2014

Cardiovasc Ultrasound

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BackgroundStudies assessing ischemic mitral regurgitation (IMR) comprised of heterogeneous population and evaluated IMR in the subacute setting. The incidence of early IMR in the setting of primary PCI, its progression and clinical impact over time is still undetermined. We sought to determine the predictors and prognosis of early IMR after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).MethodsUsing our primary PCI database, we screened for patients who underwent ≥2 transthoracic echocardiograms early (1–3 days) and late (1 year) following primary PCI. The primary outcomes were: (1) major adverse events (MACE) including death, ischemic events, repeat hospitalization, re-vascularization and mitral repair or replacement (2) changes in quantitative echocardiographic assessments.ResultsFrom January 2006 to July 2012, we included 174 patients. Post-primary PCI IMR was absent in 95 patients (55%), mild in 60 (34%), and moderate to severe in 19 (11%). Early after primary PCI, IMR was independently predicted by an ischemic time > 540 min (OR: 2.92 [95% CI, 1.28 – 7.05]; p = 0.01), and female gender (OR: 3.06 [95% CI, 1.42 – 6.89]; p = 0.004). At a median follow-up of 366 days [34–582 days], IMR was documented in 44% of the entire cohort, with moderate to severe IMR accounting for 15%. During follow-up, MR regression (change ≥ 1 grade) was seen in 18% of patients. Moderate to severe IMR remained an independent predictor of MACE (HR: 2.58 [95% CI, 1.08 – 5.53]; p = 0.04).ConclusionsAfter primary PCI, IMR is a frequent finding. Regression of early IMR during long-term follow-up is uncommon. Since moderate to severe IMR post-primary PCI appears to be correlated with worse outcomes, close follow-up is required.

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Section: Introductionmentioning

confidence: 99%

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

MacHaalany

Bertrand

O’Connor

et al. 2014

Cardiovasc Ultrasound

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“…Mild MR in acute inhospital MI setting is not a significant prognostic factor of adverse events. This finding suggests the possibility of more important predictive role of mild MR to long-term follow-up outcomes, which is increasingly reported in the literature [3][4][5]8,11,12,18]. …”

Section: Discussionmentioning

confidence: 85%

“…Although MR after MI is a frequently reported echocardiographic finding, significant (moderate and severe) MR is less prevalent [3]. Recently even mild MR was recognized as an important risk factor contributing to increased risk of heart failure and death after MI during a long-term follow up [2,4].…”

Section: Introductionmentioning

confidence: 99%

Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

2015

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“…19 Moderate/severe MR is common after HF and AMI, which was reported in 16%-43% of patients. [20][21][22][23] In China, 4 million people had been estimated to be living with HF and by 2030 the country is estimated to have over 23 million patients with AMIs each year (nearly three times as many as that in 2010). [24][25][26] In HF and AMI cohorts, moderate or severe FMR affects up to 30% of Chinese patients.…”

Section: Epidemiology and Prognostic Impact Of Fmrmentioning

confidence: 99%

Update on surgical repair in functional mitral regurgitation

Lee

Wei

et al. 2021

Journal of Cardiac Surgery

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Background: Functional mitral regurgitation (FMR) is common in patients with myocardial infarction or dilated cardiomyopathy, and portends a poor prognosis despite guideline-directed medical therapy (GDMT). Surgical or transcatheter mitral repair for FMR from recent randomized clinical trials showed disappointing or conflicting results.Aims: To provide an update on the role of surgical repair in the management of FMR. Materials and Methods: A literature search was conducted utilizing PubMed, Ovid, Web of Science, Embase, and Cochrane Library. The search terms included secondary/FMR, ischemic mitral regurgitation, mitral repair, mitral replacement, mitral annuloplasty, transcatheter mitral repair, and percutaneous mitral repair. Randomized clinical trials over the past decade were the particular focus of the current review. Results: Recent data underlined the complexity and poor prognosis of FMR. GDMT and cardiac resynchronization, when indicated, should always be applied. Accurate assessment of the interplay between ventricular geometry and mitral valve function is essential to differentiate proportionate FMR from the disproportionate subgroup, which could be helpful in selecting appropriate transcatheter intervention strategies. Surgical repair, most commonly performed with an undersized ring annuloplasty, remains controversial. Adjunctive valvular or subvalvular repair techniques are evolving and may produce improved results in selected FMR patients. Conclusion: FMR resulted from complex valve-ventricular interaction and remodeling. Distinguishing proportionate FMR from disproportionate FMR is important in exploring their underlying mechanisms and to guide medical treatment with surgical or transcatheter interventions. Further studies are warranted to confirm the clinical benefit of appropriate surgical repair in selected FMR patients.

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Mitral regurgitation during a myocardial infarction – New predictors and prognostic significance at two years of follow-up

Abstract: GRACE score for IHM, GFR and admission haemoglobin independently predicted risk for pre-discharge MR. MR, including its milder form, was an independent predictor of 2-year mortality, adding prognostic power to GRACE score.

Cited by 9 publications

References 17 publications

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

Predictors and prognosis of early ischemic mitral regurgitation in the era of primary percutaneous coronary revascularisation

Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

Update on surgical repair in functional mitral regurgitation

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