Key result
Moderate or severe functional mitral regurgitation was independently associated with new-onset atrial fibrillation in patients with acute myocardial infarction (OR 2.1; 95% CI 1.2 to 3.6, p=0.007).
Why the study?
Does functional mitral regurgitation predict new-onset atrial fibrillation in patients with acute myocardial infarction?
Cohort (n=1,920)
No
Does functional mitral regurgitation predict new-onset atrial fibrillation in patients with acute myocardial infarction?
Odds Ratio: 2.1 (95% CI 1.2–3.6)
Absolute Event Rate: 18.7% vs 5%
p-value: p=0.007
Functional mitral regurgitation severity is independently associated with new-onset atrial fibrillation during hospitalization for acute myocardial infarction, particularly in patients with reduced ejection fraction.
May warrant closer AF monitoring in AMI with moderate-severe FMR; leaves open whether MR modification alters AF risk.
BACKGROUND/OBJECTIVE: The role of factors that increase left atrial pressure or cause acute left atrial dilatation is frequently emphasised in the pathogenesis of atrial fibrillation (AF) in patients with acute myocardial infarction (AMI). This study was designed to test the hypothesis that functional mitral regurgitation (FMR) occurring after AMI may promote AF by producing left atrial volume overload. SETTING: Intensive care unit of a tertiary care hospital. PATIENTS AND METHODS: 1920 patients admitted with AMI were studied. Patients with known AF were excluded. FMR was classified using echocardiography into three groups: none; mild FMR and moderate or severe FMR. The relationship between FMR and AF occurring at any time during the hospital course was examined using multivariable logistic regression. RESULTS: Mild FMR was present in 744 patients (38.8%) and moderate or severe FMR was present in 150 patients (7.8%). AF developed in 51 (5.0%), 83 (11.2%) and 28 (18.7%) patients with no FMR, mild FMR and moderate or severe FMR, respectively (p trend <0.001). In multivariable logistic regression, both mild (odds ratio (OR) 1.6; 95% CI 1.1 to 2.3, p=0.02) and moderate or severe FMR (OR 2.1; 95% CI 1.2 to 3.6, p=0.007) were independent predictors of AF. There was a significant interaction between the left ventricular ejection fraction and FMR (p=0.003) such that mild FMR was predictive of AF only in patients with a reduced (<45%) ejection fraction. CONCLUSIONS: There is a graded independent association between the severity of FMR and the new onset of AF in patients with AMI.
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Bahouth et al. (2010) conducted a cohort in Acute myocardial infarction (n=1,920). Functional mitral regurgitation vs. No functional mitral regurgitation was evaluated on New-onset atrial fibrillation during the hospital course (OR 2.1, 95% CI 1.2 to 3.6, p=0.007). Moderate or severe functional mitral regurgitation was independently associated with new-onset atrial fibrillation in patients with acute myocardial infarction (OR 2.1; 95% CI 1.2 to 3.6, p=0.007).
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