Abstract
This editorial refers to ‘Prognostic influence of mitral regurgitation prior to a first myocardial infarction’† by J. Zamorano et al. , on page 343 Coronary artery disease (CAD) prognosis has been known for many years to depend on many factors, including the degree of left ventricular (LV) dysfunction as well as the presence of inducible ischaemia, viable dysfunctioning myocardium, and degree of coronary artery lesions. Mitral regurgitation (MR) is often a bystander and is a frequent finding after acute myocardial infarction (AMI) (in 15–64% of patients). It is an independent predictor of cardiovascular mortality,1–4 and results from many factors, such as papillary muscle dysfunction and/or mitral annulus dilatation, and LV remodelling with papillary muscle migration causing malcoaptation of the leaflets and excess valvular tenting with loss of systolic annular contraction.2 Myocardial viability in the infarct area reduces infarct expansion and ventricular remodelling, and prevents the development of MR. In the study by Golia et al. 1 of 191 patients after uncomplicated AMI, MR was present in 58.6% of the patients and it was significant (>grade 1) in 26 patients (13.6%). It was associated with increased age, lower regional wall motion score index during dobutamine stress echocardiography, more severe CAD, and more frequent anterior/inferior infarctions. At multivariate analysis the extent of LV dysfunction and the presence of MR were significantly related to mortality. Auscultation may not detect a murmur due to decreased turbulence, and echocardiography should be performed routinely on all patients for diagnosis. A regurgitant volume ≥30 mL, or an effective regurgitant orifice ≥2 mm2 defines a high-risk group.4,5 Many papers have focused on the importance of correcting MR during coronary artery bypass grafting (CABG) for a better long-term prognosis, even when there is no definite major organic cause (such … *Tel: +351 21 8465469; fax: +351 21 8465469. E-mail address: branco.online{at}mail.telepac.pt
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