Key result
The degree of acute mitral regurgitation quantified by 4D flow CMR was significantly associated with the extent of microvascular obstruction in patients with reperfused STEMI (R = 0.54).
Why the study?
Mitral regurgitation and microvascular obstruction are common complications of myocardial infarction, but their association post-reperfusion required investigation.
Does the degree of acute mitral regurgitation associate with the extent of microvascular obstruction in patients with reperfused STEMI?
Cohort (n=69)
No
Does the degree of acute mitral regurgitation associate with the extent of microvascular obstruction in patients with reperfused STEMI?
In patients with reperfused STEMI, the degree of acute mitral regurgitation quantified by 4D flow CMR is independently associated with the extent of microvascular obstruction.
OBJECTIVES: Mitral regurgitation (MR) and microvascular obstruction (MVO) are common complications of myocardial infarction (MI). This study aimed to investigate the association between MR in ST-elevation MI (STEMI) subjects with MVO post-reperfusion. STEMI subjects undergoing primary percutaneous intervention were enrolled. Cardiovascular magnetic resonance (CMR) imaging was performed within 48-hours of initial presentation. 4D flow images of CMR were analysed using a retrospective valve tracking technique to quantify MR volume, and late gadolinium enhancement images of CMR to assess MVO. RESULTS: Among 69 patients in the study cohort, 41 had MVO (59%). Patients with MVO had lower left ventricular (LV) ejection fraction (EF) (42 ± 10% vs. 52 ± 8%, P < 0.01), higher end-systolic volume (98 ± 49 ml vs. 73 ± 28 ml, P < 0.001) and larger scar volume (26 ± 19% vs. 11 ± 9%, P < 0.001). Extent of MVO was associated with the degree of MR quantified by 4D flow (R = 0.54, P = 0.0003). In uni-variate regression analysis, investigating the association of CMR variables to the degree of acute MR, only the extent of MVO was associated (coefficient = 0.27, P = 0.001). The area under the curve for the presence of MVO was 0.66 (P = 0.01) for MR > 2.5 ml. We conclude that in patients with reperfused STEMI, the degree of acute MR is associated with the degree of MVO.
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Assadi et al. (2022) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=69). Acute mitral regurgitation vs. Lower degree or absence of mitral regurgitation was evaluated on Correlation between the degree of acute mitral regurgitation and the extent of microvascular obstruction (Pearson correlation = 0.54, 95% CI 0.28-0.73, p=0.0003). The degree of acute mitral regurgitation quantified by 4D flow CMR was significantly associated with the extent of microvascular obstruction in patients with reperfused STEMI (R = 0.54).
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