A Longitudinal Study of Mitral Regurgitation Detected after Acute Myocardial Infarction.

Harish Sharma,Iqra Shakeel,James Hodson,Saul G Myerson,Ashwin Radhakrishnan,John May,Nawal Zia,Peter F Ludman,Mengshi Yuan,Jonathan N Townend,Kieran O’Connor,M Adnan Nadir,Richard P Steeds,Sandeep S Hothi,Sagar N Doshi,Samuel Brown

doi:10.3390/jcm11040965

Abstract

Background: Mitral regurgitation (MR) is common following myocardial infarction (MI). However, the subsequent trajectory of MR, and its impact on long-term outcomes are not well understood. This study aimed to examine the change in MR severity and associated clinical outcomes following MI. Methods: Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined. Results: 294/1000 consecutive patients had MR on baseline (pre-discharge) transthoracic echocardiography (TTE), of whom 126 (mean age: 70.9 ± 11.4 years) had at least one follow-up TTE. At baseline, most patients had mild MR (n = 94; 75%), with n = 30 (24%) moderate and n = 2 (2%) severe MR. Significant improvement in MR was observed at the first follow-up TTE (median 9 months from baseline; interquartile range: 3–23), with 36% having reduced severity, compared to 10% having increased MR severity (p < 0.001). Predictors of worsening MR included older age (mean: 75.2 vs. 66.7 years; p = 0.003) and lower creatinine clearance (mean: 60 vs. 81 mL/min, p = 0.015). Change in MR severity was significantly associated with prognosis: 16% with improving MR reached the composite endpoint of death or heart failure hospitalisation at 5 years, versus 44% (p = 0.004) with no change, and 59% (p < 0.001) with worsening MR. Conclusions: Of patients with follow-up TTE after MI, MR severity improved from baseline in approximately one-third, was stable in around half, with the remainder having worsening MR. Patients with persistent or worsening MR had worse clinical outcomes than those with improving MR.

Highlights

Mitral regurgitation (MR) is found in up to 29% of patients following acute myocardial infarction (MI) [1,2,3]
Due to a paucity of longitudinal studies, it is currently unclear whether the severity of MR observed immediately after acute MI changes with time, or whether such a change is associated with adverse prognosis
A similar analysis was performed for the outcome of moderate-to-severe MR. Since these analyses found no significant trends over time in MR severity after the initial step-change, subsequent analysis was based on comparisons of MR severity on the baseline vs. final follow-up transthoracic echocardiography (TTE) for each patient

Summary

Introduction

Mitral regurgitation (MR) is found in up to 29% of patients following acute myocardial infarction (MI) [1,2,3]. MR [1,2]; even mild MR can be associated with poorer outcomes [4]. Long-term prognosis worsens in proportion to the severity of MR, such that patients with moderate or severe MR have only a 70% 5-year survival rate, even in the absence of significant LV impairment [1]. Due to a paucity of longitudinal studies, it is currently unclear whether the severity of MR observed immediately after acute MI changes with time, or whether such a change is associated with adverse prognosis. Mitral regurgitation (MR) is common following myocardial infarction (MI). This study aimed to examine the change in MR severity and associated clinical outcomes following MI. Methods: Records of patients admitted to a single centre between 2016 and 2017 with acute MI treated by percutaneous coronary intervention (PCI) were retrospectively examined

Objectives

Methods

Discussion

Conclusion