Abstract
Introduction: Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. However, few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Aim: Investigate the clinical predictors of ischemic MR and its impact on the outcome after 1st NSTEMI . Methods: 40 consecutive patients were selected retrospectively after a first NSTEMI. Each underwent echocardiography and coronary angiography during their hospital admission. Patients were divided into two groups according to the presence or absence of MR at echocardiography: Group I : 20 patients without MR , Group II : 20 patients with MR. The patients were followed up clinically for at least one year. The incidence of readmission for heart failure, unstable angina, reinfarction, or all combined (i.e, major adverse cardiac event [MACE]) was recorded. Results: The patients’ mean age was 59.62 ± 10.97 years and 67.5 % were male. They were followed–up for a median of 640.5 days . No significant differences between both groups regarding baseline data ,cardiac isoenzymes , or revascularization (P > 0.05) , but there was significantly increased number of diseased coronary arteries in MR group (P 0.04). LA diameter was significantly increased with decreased LVEF% and increased wall motion abnormalities in MR group ((P < 0.05) . During follow-up period ,more admissions for unstable angina were seen in patients with MR but with little significance (P 0.05) . Regarding MACE, a greater incidence was found in the MR group (P<.05). Using Kaplan-Meier curves ,a long-term association of MACE with the presence of MR was found (P 0.04), and a higher grades of MR were associated with poor prognosis (P .05) . In conclusion: Ischemic MR yield poor prognosis. Thus, current MR should be carefully assessed after an NSTEMI,and probably requires even more meticulous treatment including early revascularization and stricter follow-up than usual .
Highlights
Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis
Initial echocardiographic parameters in the 2 groups (Table 2) Left atrial diameter was significantly increased in non-ST-segment elevation acute myocardial infarction (NSTEMI) patients with MR (P < 0.001)
The appearance of mitral regurgitation (MR) in the setting of myocardial ischemia could be due to discrepancy of tethering force and closing force or papillary muscle displacement owing to remodeled left ventricle [23]
Summary
Ischemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. Few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Ischemic mitral regurgitation (MR) conveys adverse prognosis, doubling mortality after myocardial infarction (MI), in chronic heart failure, and after surgical or catheter revascularization [1, 2]. Previous studies have focused on STelevation myocardial infarction, during the short or medium term and ischemic MR [1, 4]. Few studies have addressed the role of functional MR in risk stratification in patients with NSTEMI during the long- term and even the short- term [9, 10, 11]
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