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Background-Myocardial infarction (MI) can directly cause ischemic mitral regurgitation (IMR), which has been touted as an indicator of poor prognosis in acute and early phases after MI. However, in the chronic post-MI phase, prognostic implications of IMR presence and degree are poorly defined. Methods and Results-We analyzed 303 patients with previous (Ͼ16 days) Q-wave MI by ECG who underwent transthoracic echocardiography: 194 with IMR quantitatively assessed in routine practice and 109 without IMR matched for baseline age (71Ϯ11 versus 70Ϯ9 years, Pϭ0.20), sex, and ejection fraction (EF, 33Ϯ14% versus 34Ϯ11%, Pϭ0.14). In IMR patients, regurgitant volume (RVol) and effective regurgitant orifice (ERO) area were 36Ϯ24 mL/beat and 21Ϯ12 mm 2 , respectively. After 5 years, total mortality and cardiac mortality for patients with IMR (62Ϯ5% and 50Ϯ6%, respectively) were higher than for those without IMR (39Ϯ6% and 30Ϯ5%, respectively) (both PϽ0.001). In multivariate analysis, independently of all baseline characteristics, particularly age and EF, the adjusted relative risks of total and cardiac mortality associated with the presence of IMR (1.88, Pϭ0.003 and 1.83, Pϭ0.014, respectively) and quantified degree of IMR defined by RVol Ն30 mL (2.05, Pϭ0.002 and 2.01, Pϭ0.009) and by ERO Ն20 mm 2 (2.23, Pϭ0.003 and 2.38, Pϭ0.004) were high. Conclusions-In the chronic phase after MI, IMR presence is associated with excess mortality independently of baseline characteristics and degree of ventricular dysfunction. The mortality risk is related directly to the degree of IMR as defined by ERO and RVol. Therefore, IMR detection and quantification provide major information for risk stratification and clinical decision making in the chronic post-MI phase.

The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

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