Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction

Bahouth, Fadel; Mutlak, Diab; Furman, Moran; Musallam, Anees; Hammerman, Haim; Lessick, Jonathan; Dabbah, Saleem; Reisner, Shimon A.; Agmon, Yoram; Aronson, Doron

doi:10.1136/hrt.2009.183822

Cited by 38 publications

(39 citation statements)

References 31 publications

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“…It has recently been demonstrated that a moderate mitral regurgitation after an acute myocardial infarction affects the degree of ventricular remodelling through different molecular and cellular mechanisms 15. This suggests that FMR is not simply a bystander but has a direct effect on excess remodelling, enhanced risk of atrial fibrillation16 and subsequent clinical events 17…”

Section: Discussionmentioning

confidence: 99%

Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy

Rossi¹,

Dini

Faggiano

et al. 2011

Heart

491

293

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Background Functional mitral regurgitation (FMR) is a common finding in patients with heart failure (HF), but its effect on outcome is still uncertain, mainly because in previous studies sample sizes were relatively small and semiquantitative methods for FMR grading were used. Objective To evaluate the prognostic value of FMR in patients with HF. Methods and results Patients with HF due to ischaemic and non-ischaemic dilated cardiomyopathy (DCM) were retrospectively recruited. The clinical end point was a composite of all-cause mortality and hospitalisation for worsening HF. FMR was quantitatively determined by measuring vena contracta (VC) or effective regurgitant orifice (ERO) or regurgitant volume (RV). Severe FMR was defined as ERO >0.2 cm 2 or RV >30 ml or VC >0.4 cm. Restrictive mitral filling pattern (RMP) was defined as E-wave deceleration time <140 ms. The study population comprised 1256 patients (mean age 67611; 78% male) with HF due to DCM: 27% had no FMR, 49% mild to moderate FMR and 24% severe FMR. There was a powerful association between severe FMR and prognosis (HR¼2.0, 95% CI 1.5 to 2.6; p<0.0001) after adjustment of left ventricular ejection fraction and RMP. The independent association of severe FMR with prognosis was confirmed in patients with ischaemic DCM (HR¼2.0, 95% CI 1.4 to 2.7; p<0.0001) and nonischaemic DCM (HR¼1.9, 95% CI 1.3 to 2.9; p¼0.002). Conclusion In a large patient population it was shown that a quantitatively defined FMR was strongly associated with the outcome of patients with HF, independently of LV function.

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Section: Discussionmentioning

confidence: 99%

Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy

Rossi¹,

Dini

Faggiano

et al. 2011

Heart

491

293

View full text Add to dashboard Cite

show abstract

“…Mitral regurgitation has a well-recognized association with AF, 78 and more severe mitral regurgitation has been shown to predict progression from paroxysmal AF to permanent AF, 79 incident AF after myocardial infarction, 80 and AF recurrence after PV isolation. 81 A study by Maeillo et al 82 noted that LA enlargement in the setting of mitral regurgitation tends to be more spherical than that occurring with diastolic dysfunction, which tends to be more eccentric, suggesting that the more spherical modeling is more relevant to the development of AF.…”

Section: Clinical Studies Of Af and Diastolic Dysfunctionmentioning

confidence: 99%

Diastolic Dysfunction and Risk of Atrial Fibrillation

2012

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A trial fibrillation (AF) is the most common sustained arrhythmia, and its prevalence in the population is increasing. 1 Diastolic dysfunction shares many common risk factors with AF, including age, hypertension, 2-5 obesity, 6,7 and diabetes. 8,9 Like AF, diastolic dysfunction increases with age, 10 and patients given the diagnosis of diastolic dysfunction are more likely to have AF at the time. 11 Diastolic dysfunction has significant pathological effects on atrial structure and function, many of which are proarrhythmic. However, much remains to be learned about the specific mechanisms through which diastolic dysfunction ultimately promotes AF.Previous reviews have examined the broad association of diastolic dysfunction and AF. 12 In this review, we attempt to examine this association on a mechanistic level. We begin with a basic review of the physiology of diastolic function, with particular attention to the complex interaction between the atrium and the ventricle during diastole. We then provide an overview of some of the most common clinical methods to quantify diastolic function and highlight the strengths and weaknesses of these methods with regard to providing an accurate picture of this physiology. We describe how these methods are applied to diagnose diastolic dysfunction, including the development of a widely adopted classification scheme of diastolic dysfunction. We then review the limited clinical data available connecting diastolic dysfunction with the risk of incident, nonvalvular AF, with a focus on studies examining diastolic dysfunction in populations without structural heart disease-ie, with preserved systolic function in the absence of hypertrophic cardiomyopathic disease or congenital heart disease. Finally, we attempt to reconcile the results of these clinical studies with experimental data in both human, animal, and cellular models, to create a mechanistic link between diastolic dysfunction and pathological changes that increase the likelihood of AF. Atrial and Ventricular Diastolic DynamicsA number of excellent resources are available for more detailed review of the dynamics of ventricular diastole, including invasive 13 and noninvasive 14 -17 descriptions. Ventricular diastole is the period of the cardiac cycle that begins with the closure of the aortic valve and ends with mitral valve closure, during which the ventricle is filling with blood. It can be further divided into 4 sequential components: (1) isovolumic relaxation, (2) early rapid filling, (3) diastasis, and (4) atrial systole (late filling). Dynamically, none of the components is completely independent of each other, or the systolic function of the heart, and changes in one can influence the others in predictable and unpredictable ways.Essentially, there are 2 characteristics of ventricular function that contribute to diastolic function: relaxation (lusitropy) and compliance. Relaxation refers to the process by which the ventricular pressure drops after contraction to a level below that of the atrium, causing blood to flow dow...

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“…Reports on whether the left ventricular (LV) infarction localization is a risk factor for MR severity differ: the incidence of ischemic MR has been reported to be higher in inferior compared to anterior MI localization [1,6,15]; however, the difference in incidence of moderate or severe MR based on MI localization was reported as insignificant by other author teams [3,12].…”

Section: Discussionmentioning

confidence: 94%

“…It is reasonable to expect some overlap between these two clinical entities, however incidence and prevalence of significant MR is much higher in MI population or patients with prior MI, indicating important role of myocardial ischemia and LV remodeling [5,6]. Important role of LV remodeling is further supported by identifiable predictors of ischemic MR, confirmed and consistent with minor variations throughout the published studies and our results: extent of CAD, previous MI, larger LV dimensions and volumes, and decreased LV systolic function [2,3,11,12,15].…”

Section: Discussionmentioning

confidence: 99%

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Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

2015

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Relationship of functional mitral regurgitation to new-onset atrial fibrillation in acute myocardial infarction

Abstract: There is a graded independent association between the severity of FMR and the new onset of AF in patients with AMI.

Cited by 38 publications

References 31 publications

Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy

Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy

Diastolic Dysfunction and Risk of Atrial Fibrillation

Functional (ischemic) mitral regurgitation in acute phase of myocardial infarction: Associated clinical factors and in-hospital outcomes

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