Ischemic Mitral Regurgitation and Risk of Heart Failure After Myocardial Infarction

Abstract

Background: The development of ischemic mitral regurgitation (MR) after myocardial infarction may impose hemodynamic load during a period of active left ventricular remodeling and promote heart failure (HF). However, few data are available on the relationship between ischemic MR and the long-term risk for HF. Methods: We prospectively studied 1190 patients admitted for acute myocardial infarction. Mitral regurgitation was assessed by echocardiography and was considered mild, moderate, and severe when the regurgitant jet area occupied less than 20%, 20% to 40%, and greater than 40% of the left atrial area, respectively. The median duration of follow-up was 24 months (range, 6-48 months). Results: Mild and moderate or severe ischemic MR was present in 39.7% and 6.3% of patients, respectively. After adjusting for ejection fraction and clinical variables (age, sex, Killip class, previous infarction, hypertension, diabetes mellitus, anterior infarction, ST-elevation infarction, and coronary revascularization), compared with patients without MR, the hazard ratios for HF were 2.8 (95% confidence interval [CI], 1.8-4.2; PϽ.001) and 3.6 (95% CI, 2.0-6.4; PϽ.001) in patients with mild and moderate or severe ischemic MR, respectively. The adjusted hazard ratios for death were 1.2 (95% CI, 0.8-1.8; P=.43) and 2.0 (95% CI, 1.2-3.4; P=.02) in patients with mild and moderate or severe MR, respectively. Conclusions: There is a graded independent association between the severity of ischemic MR and the development of HF after myocardial infarction. Even mild ischemic MR is associated with an increase in the risk of HF.

Echocardiographic evaluation of systolic heart failure

“…A similar increase in mortality over the longer term (five years) with ischaemic MR was reported 26 . Ischemic MR also predicts the development of HF in AMI patients with a little or no symptoms at baseline 119 and HF risk with moderate to severe MR was ~50% at two years in one series 120 .…”

Primary Percutaneous Coronary Intervention Lowers the Incidence of Ischemic Mitral Regurgitation in Patients With Acute ST-Elevated Myocardial Infarction

“…The ensuing chamber dilatation and neurohormonal activation lead to progressive LV dysfunction. 6 The presence of IMR further inflicts the hemodynamic load during a period of active LV remodeling. 7, 16 Aronson et al reported that there is a graded independent association between the severity of ischemic MR and the development of heart failure after MI.…”

“…7, 16 Aronson et al reported that there is a graded independent association between the severity of ischemic MR and the development of heart failure after MI. 6 Ishikawa et al reported ischemic MR to be a common cause of congestive heart failure, caused by the process of MI remodeling. 22 The present study further strengthens the context of LV remodeling in the presence of IMR, in that it eventually associates with a lower LVEF and a higher Killip score.…”

Coronary Artery Bypass Surgery With or Without Mitral Valve Annuloplasty in Moderate Functional Ischemic Mitral Regurgitation

“…1,2 It is usually mild or moderate in severity but is associated with an increased incidence of heart failure and death. 1,2 It is caused by left ventricular (LV) remodeling and dilatation after myocardial infarction, which tethers and pulls the mitral valve apart, resulting in MR; the mitral valve is normal in structure but is incompetent as a result of a dilated and dysfunctional left ventricle. 3,4 The majority have significant 3-vessel coronary artery disease and benefit from coronary artery bypass grafting (CABG).…”