Ischemic mitral regurgitation after myocardial infarction significantly increased the 5-year risk of congestive heart failure compared to no mitral regurgitation (53% vs 18%; RR 3.65; 95% CI 1.86-7.75).
Cohort (n=173)
Relative Risk: 3.65 (95% CI 1.86–7.75)
Absolute Event Rate: 53% vs 18%
p-value: p=<0.0001
OBJECTIVES: The purpose of this study was to define the contribution of ischemic mitral regurgitation (IMR) to the occurrence of congestive heart failure (CHF) after myocardial infarction (MI). BACKGROUND: After MI, CHF is a frequent and serious complication, but its determinants and, particularly, the role of IMR are poorly defined. METHODS: We analyzed 173 asymptomatic patients with previous Q-wave MI (>16 days) with echocardiographic quantitation of IMR (measuring effective regurgitant orifice ERO and regurgitant volume). The 102 patients with IMR were matched to 71 patients without IMR for age (71 +/- 11 years vs. 68 +/- 9 years; p = 0.11), gender (76% vs. 82% males; p = 0.41), and left ventricular ejection fraction (EF) (37 +/- 14% vs. 36 +/- 11%; p = 0.92). RESULTS: Five-year rates of CHF and of CHF or cardiac death (CD) were 36 +/- 5% and 52 +/- 5%, respectively. Independent determinants of CHF were EF, sodium plasma level, and presence and degree of IMR (p or =20 mm(2) (all p or =20 mm(2). The adjusted relative risk of CHF/CD was 2.97 (95% CI 1.77 to 5.16) for IMR presence and 4.4 (95% CI 2.4 to 8.2) for ERO > or =20 mm(2). CONCLUSIONS: After MI, incidence of CHF and of CHF/CD are high even in patients with no or minimal symptoms at baseline and are higher in patients with IMR. Congestive heart failure is independently determined by larger ERO of IMR. These data suggest that detecting and quantifying IMR is essential for risk stratification after MI. Value of IMR treatment in improving post-MI outcome should be investigated.
“What is clear is that the advent of secondary MR worsens prognosis, but it is unclear whether poorer outcome stems from the MR itself or is simply a marker for worsening LV function and heart failure.”
Grigioni et al. (Sat,) conducted a cohort in Previous Q-wave myocardial infarction (n=173). Ischemic mitral regurgitation (IMR) vs. No mitral regurgitation was evaluated on Congestive heart failure (CHF) (RR 3.65, 95% CI 1.86-7.75, p=<0.0001). Ischemic mitral regurgitation after myocardial infarction significantly increased the 5-year risk of congestive heart failure compared to no mitral regurgitation (53% vs 18%; RR 3.65; 95% CI 1.86-7.75).