Prognostic importance of mitral regurgitation complicated by acute myocardial infarction during a 5-year follow-up period in the drug-eluting stent era

Kim, Tae-Hoon; Lee, Kwan Yong; Choi, Young Jin; Park, Ha-Wook; Lee, Young Soo; Koh, Yoon Seok; Park, Hun‐Jun; Kim, Pum-Joon; Chang, Kiyuk; Chung, Wook Sung; Kim, Dong‐Bin; Her, Sung-Ho; Park, Chul Soo; Lee, Jong Min; Kim, Hee-Yeol; Yoo, Ki Dong; Jeon, Doo Soo; Ahn, Youngkeun; Cho, Jeong Gwan; Seung, Ki‐Bae

doi:10.1097/mca.0000000000000324

Cited by 4 publications

(5 citation statements)

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“…1 The prevalence of ischemic MR varies from 11-59 % based on timing and techniques used. 2,3,7,9 All enrolled cases of acute MI underwent successful revascularization either in form of balloon dilation with stenting or balloon angioplasty (POBA) alone to establish blood flow in the distal artery. We found moderate to severe MR in an echocardiographic study in 27.4 % of the study population.…”

Section: Discussionmentioning

confidence: 99%

“…1 Based on timing and technique used, the prevalence of mitral regurgitation varies from 11% to 59%, and around half of them reported to have moderate to severe regurgitation. 2,3 The risk factors include advanced age, prior myocardial infarction, infero-posterior wall involvement, infarct extension, and recurrent ischemia. 4 Mitral regurgitation that develops in patients of acute myocardial infarction leads to short and long-term mortality.…”

Section: Introductionmentioning

confidence: 99%

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Mitral Regurgitation and its Predictors after Acute Myocardial Infarction in the Era of Coronary Intervention

2021

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Introduction Mitral regurgitation is one of the common complications of acute Myocardial infarction but a very limited study was published about its prevalence and associated factors from Nepal. Methods A prospective cross-sectional study was conducted in admitted patients of the cardiology unit, Manipal Teaching Hospital from 01-06- 2020 to 15-09-2021. All cases of first time acute myocardial infarction who were presented within 12 hours of symptom onset and undergone revascularization with the coronary intervention were selected for the study Results A total of 219 patients with a mean age of 60.55± 12.5 years were taken for study. Moderate to severe mitral regurgitation was detected in 60 (27.4%) cases. The most common risk factors among responders were overweight followed by low high-density lipoprotein and smoking. Age >65yrs [OR:8.26(95%CI, 1.82-37.52); p=0.006], female gender [OR:2.05(95% CI,1.12-3.76); p=0.019], pre-obesity [OR: 2.43(95% CI, 1.14-5.17); P=0.019], longer ischemic time of >6 hrs [OR: 4.57(95%CI, 2.10-9.91); P= 0.001] and involvement of infero-posterior wall[OR: 3.04(95%CI, 1.61-5.774); P= 0.001] and left circumflex artery involvement [OR: 7.67(95%CI, 3.15-18.63); P= 0.001] were significantly associated with moderate to severe ischemic mitral regurgitation. Conclusion Mitral regurgitation is a common complication of acute myocardial ischemia. Elderly age, Female gender, longer ischemic time of more than six hours, involvement of infero-posterior wall and left circumflex artery was significantly associated with moderate to severe mitral regurgitation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mitral Regurgitation and its Predictors after Acute Myocardial Infarction in the Era of Coronary Intervention

2021

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“…Even mild IMR detected 2 days after admission for acute MI is a factor of reduced 1‐year survival 10 . These findings were confirmed even in the drug‐eluting stents era 11‐13 . Medical treatment has suboptimal results, as the presence of IMR is a risk factor for heart failure and death 6,14,15 .…”

Section: Introductionmentioning

confidence: 91%

“…10 These findings were confirmed even in the drug-eluting stents era. [11][12][13] Medical treatment has suboptimal results, as the presence of IMR is a risk factor for heart failure and death. 6,14,15 Percutaneous or surgical revascularization alone are only partially successful in eliminating or reducing IMR.…”

Section: Introductionmentioning

confidence: 99%

An observational, prospective study on surgical treatment of secondary mitral regurgitation: The SMR study. Rationale, purposes, and protocol

Calafiore¹,

Mauro

Bonatti³

et al. 2020

J Card Surg

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The natural history of secondary mitral regurgitation (MR) is unfavorable. Nevertheless, there are no evidence that its correction can improve the outcome. If from one side the original cause of secondary MR can be such to limit the possibilities of improvement, from the other side it is possible that the surgical technique widely applied to repair, restrictive mitral annuloplasty, is not adequate to correct the regurgitation. The addition of valvular and/or subvalvular techniques has been considered a possible technical solution. However, we do not know the prevalence of each technique, how many times mitral replacement is used to correct secondary MR. This aspect is of particular importance, as we know that a successful mitral repair causes a better left ventricular systolic remodeling than a unsuccessful repair or replacement. This study is a prospective, observational registry, conceived to understand what is done in the real world. Any surgeon will use the technique he thinks the most suitable for the patient. Every year, for 5 years, patients will have a clinical and echocardiographic follow‐up, to evaluate the risk factors for a worse result (death, rehospitalization for heart failure, reoperation for MR return, moderate, or more MR return). This knowledge will give us the possibility to understand which is the technique, or the strategy, more efficient to treat this disease and the real efficacy of the surgical treatment.

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“…Определение количественных показателей ИМР позволяет объективно оценить тяжесть регургитации в отличие от качественных и полуколичественных методов исследования, которые преимущественно используются в практической кардиологии. Учитывая клиническую значимость ИМР, противоречивые данные об эффективности реперфузионной терапии и хирургических методов лечения пациентов с ИМР, следует признать, что проблема ИМР до настоящего времени не решена и является актуальной в современной кардиологии [3][4][5].…”

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Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction

et al. 2019

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Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.

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Prognostic importance of mitral regurgitation complicated by acute myocardial infarction during a 5-year follow-up period in the drug-eluting stent era

Abstract: MR after AMI in patients successfully treated with primary PCI was associated with poor long-term outcome regardless of ST-segment elevation at diagnosis during the drug-eluting stent era.

Cited by 4 publications

References 26 publications

Mitral Regurgitation and its Predictors after Acute Myocardial Infarction in the Era of Coronary Intervention

Mitral Regurgitation and its Predictors after Acute Myocardial Infarction in the Era of Coronary Intervention

An observational, prospective study on surgical treatment of secondary mitral regurgitation: The SMR study. Rationale, purposes, and protocol

Effect of Myocardial Reperfusion on Ischemic Mitral Regurgitation in Patients with Acute Myocardial Infarction

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