The Prognostic Value of the Left Ventricular Ejection Fraction Is Dependent upon the Severity of Mitral Regurgitation in Patients with Acute Myocardial Infarction

Abstract

The prognostic value of the left ventricle ejection fraction (LVEF) after acute myocardial infarction (AMI) has been questioned even though it is an accurate marker of left ventricle (LV) systolic dysfunction. This study aimed to examine the prognostic impact of LVEF in patients with AMI with or without high-grade mitral regurgitation (MR). A total of 15,097 patients with AMI who received echocardiography were registered in the Korean Acute Myocardial Infarction Registry (KAMIR) between January 2005 and July 2011. Patients with low-grade MR (grades 0-2) and high-grade MR (grades 3-4) were divided into the following two sub-groups according to LVEF: LVEF ≤ 40% (n = 2,422 and 197, respectively) and LVEF > 40% (n = 12,252 and 226, respectively). The primary endpoints were major adverse cardiac events (MACE), cardiac death, and all-cause death during the first year after registration. Independent predictors of mortality in the multivariate analysis in AMI patients with low-grade MR were age ≥ 75 yr, Killip class ≥ III, N-terminal pro-B-type natriuretic peptide > 4,000 pg/mL, high-sensitivity C-reactive protein ≥ 2.59 mg/L, LVEF ≤ 40%, estimated glomerular filtration rate (eGFR), and percutaneous coronary intervention (PCI). However, PCI was an independent predictor in AMI patients with high-grade MR. No differences in primary endpoints between AMI patients with high-grade MR (grades 3-4) and EF ≤ 40% or EF > 40% were noted. MR is a predictor of a poor outcome regardless of ejection fraction. LVEF is an inadequate method to evaluate contractile function of the ischemic heart in the face of significant MR.

Protective effect and mechanism of estrogen receptor β on myocardial infarction in mice

“…The use of experimental animals in this study was approved by the ethics committee of our university. The general characteristics of Tg-ERβ have been reported in previous literature ( 8 ). Microinjection DNA box sequence to the C57BL/6 mouse fertilized oocytes were implanted into pseudopregnant mice.…”

“…The procedure followed for ligation of coronary artery ( 8 ) was: i) Preoperative preparation: The artery was fixed by phenobarbital anesthesia, tracheal incision intubation was undertaken after successful intubation under the use of ventilation. ii) The skin was cut; muscles were separated in the 4th intercostal level to get into the chest.…”

“…In China, with the development of economy and the improvement of living standards, the annual new onset is ≥0.5 to 2 million individuals. Although early MI can achieve good therapeutic effect through intervention and drug treatment with the improvement of the level of medical technology, MI early warning to prevent the occurrence of MI remains, however, the current research hotspot ( 6 – 8 ).…”

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

“…AMI is associated with high mortality rates and poor outcomes [1][2][3][4][5][6][7]. To date, the prognostic importance of functional MR after acute coronary syndrome has been poorly addressed, especially during the drug-eluting stent era, because MR usually resolves after ischemia resolves [8]; mostly, the observed MR has been considered to be 'functional' ischemic MR [9].…”