Predictive value of ischemic mitral regurgitation during the acute phase of ST elevation myocardial infarction treated with primary coronary intervention for left ventricular remodeling in long-term follow-up

Wita, Krystian; Berger-Kucza, Adrianna; Filipecki, Artur; Turski, Maciej; Bochenek, Tomasz; Wróbel, Wojciech; Lelek, Michał; Węglarz, Przemysław; Elżbieciak, Marek; Trusz‐Gluza, Maria

doi:10.1097/mca.0b013e32833aa6bb

Cited by 7 publications

(6 citation statements)

References 22 publications

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“…The higher than expected rate of patients with adverse LV remodeling, despite the guideline-tailored approach to management, is presumably linked to prolonged time from onset of symptoms to reperfusion therapy (mean: 294 min). In the present study, the authors focused on the phenomenon of LV reverse remodeling at 3 months after anterior wall STEMI treated with primary PCI [14, 15]. This process has previously been documented in heart failure patients subject to CRT therapy or following surgical coronary revascularization [14, 15].…”

Section: Discussionmentioning

confidence: 99%

Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Grabka¹,

Kocierz-Woźnowska²,

Wybraniec³

et al. 2018

pwki

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IntroductionThe study aimed to evaluate the prevalence and predictors of left ventricular (LV) reverse remodeling and its impact on long-term prognosis in patients with anterior ST-segment elevation myocardial infarction (STEMI).AimTo assess the percentage of reverse remodeling and its prognostic factors in anterior STEMI patients.Material and methodsThis observational study included 40 patients with first ever STEMI of the anterior wall. LV reverse remodeling was defined as the reduction of left ventricular end-systolic volume (ΔLVESV) by ≥ 10% in 3D transthoracic echocardiography (3D-TTE) at 3-month follow-up. 3D-TTE and speckle tracking imaging were performed during index hospitalization, while 3D-TTE and cardiac magnetic resonance (CMR) were performed at 3 months following the procedure. Patients were followed up for a median time of 3.4 years in order to evaluate major adverse cardiovascular events.ResultsLeft ventricular reverse remodeling at 3-month follow-up was confirmed in 15 (37.5%) patients. The presence of reverse remodeling was predicted by lower troponin levels (unit OR = 0.86, p = 0.02), lower sum of ST-segment elevations before (unit OR = 0.87, p = 0.03) and after PCI (unit OR = 0.40, p = 0.03), lower maximal ST-segment elevation after PCI (unit OR = 0.01, p = 0.03), lower wall motion score index (unit OR 0.40, p = 0.03) and more negative anterior wall global longitudinal strain (unit OR = 0.88, p = 0.045). Nine MACE were reported in the without reverse remodeling group only. Non-significantly better event-free survival in the reverse remodeling group was demonstrated (log-rank p = 0.07).ConclusionsDevelopment of reverse modeling in patients with optimal revascularization and tailored pharmacotherapy is relatively high. Further studies are warranted in order to adjudicate its prognostic role for the prediction of adverse events.

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Section: Discussionmentioning

confidence: 99%

Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Grabka¹,

Kocierz-Woźnowska²,

Wybraniec³

et al. 2018

pwki

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“…There are also findings other than LV volume or echocardiographic EF suggesting increased risk of LVR, including: significant diastolic dysfunction [ 20 ], restrictive mitral filling [ 29 ], LV dyssynchrony [ 30 ] and myocardial perfusion in contrast-enhanced echocardiography [ 31 ]. Mitral valve regurgitation is common in patients with MI (15–64%), constitutes an independent risk factor for cardiovascular mortality, and may be a predictive risk factor or even may accelerate LVR [ 32 , 33 ]. Hence, both groups in our study were comparable in baseline mitral regurgitation severity.…”

Section: Discussionmentioning

confidence: 99%

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

Liszka¹,

Haberka²,

Tabor³

et al. 2014

aoms

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IntroductionLeft ventricular remodeling (LVR) is the most prognostically important consequence of acute myocardial infarction (AMI). The aim of the study was to assess the value of speckle tracking echocardiography in the prediction of left ventricular remodeling in patients after AMI and primary coronary angioplasty (PCI).Material and methodsEighty-eight patients (F/M = 31/57 patients; 63.6 ±11 years old) with coronary artery disease (CAD) and successful PCI were enrolled and divided into group I with ST-elevation myocardial infarction or non-ST elevation myocardial infarction and group II with stable angina pectoris. Conventional and speckle tracking echocardiography was performed 3 days (baseline), 30 days and 90 days after PCI. Patients were divided into 2 groups based on the presence of LVR (increase of LV end-diastolic and/or end-systolic volume > 20%) at 3 months follow-up.ResultsAt initial presentation, 2-chamber longitudinal strain (9.4 ±3.5% vs. –11.6 ±3.6%, p < 0.04) and 4-chamber transverse strain (10.4 ±8.2% vs. 15.6 ±8%, p < 0.003) were lower in the LVR+ group compared to the LVR– group. LV wall motion score index did not differ between the two groups. After 30 days, circumferential apical and basal strain (–15.58 ±8.9% vs. –25.53 ±8.8%, p < 0.001; –15.02 ±5.6 vs. –19.78 ±6.3, p < 0.008), radial apical strain (9.96 ±8.4% vs. 14.15 ±5.5%, p < 0.03), 4-chamber longitudinal strain (–8.7 ±5.8% vs. –13.47 ±3.9%, p < 0.005), 4-chamber transverse strain (10.5 ±8.1% vs. 16.7 ±8.3%, p < 0.03), apical rotation (3.84 ±2.5° vs, 5.66 ±3.2°, p < 0.04) and torsion (6.15 ±4.1° vs. 8.98 ±4.6°, p < 0.03) were significantly decreased in the LVR+ group compared to the LVR– group. According to ROC analysis, circumferential apical strain > –15.92% (sensitivity 93%, specificity 59%, positive predictive value 90%) was the most powerful predictor of remodeling after primary PCI in AMI.ConclusionsOur results suggest that impaired indices of LV deformation detected 3 days and 30 days after AMI may provide important predictive value in LV remodeling and patients’ follow-up.

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“…The prevalence has been variable (Table 5) as it is dependent on the detection technique utilized. It ranges from <20% in angiographic studies [10-14] to as high as 60% in echocardiographic studies [1-8,15,30-33], with moderate or severe IMR accounting for <5% and 10-15% of cases, respectively. This discrepancy reflects the selection biases inherent to most studies, as most involved a heterogeneous sample size that included a mixture of STEMI and NSTEMI patients.…”

Section: Discussionmentioning

confidence: 99%

“…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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Predictive value of ischemic mitral regurgitation during the acute phase of ST elevation myocardial infarction treated with primary coronary intervention for left ventricular remodeling in long-term follow-up

Abstract: Ischemic MR in STEMI is frequent, even despite effective primary PCI. The regurgitation grade and lower LVEF assessed at hospital discharge and lack of abciximab administration could predict development of LVR at 6 months.

Cited by 7 publications

References 22 publications

Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Left ventricular reverse remodeling in patients with anterior wall ST-segment elevation acute myocardial infarction treated with primary percutaneous coronary intervention

Two-dimensional speckle-tracking echocardiography assessment of left ventricular remodeling in patients after myocardial infarction and primary reperfusion

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

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