In patients with acute inferoposterior myocardial infarction, the presence of ischemic mitral regurgitation is associated with significantly impaired radial and circumferential myocardial deformation despite similar left ventricular ejection fraction and longitudinal strain.
STE detects altered LV mechanics in acute IMR; hypothesis-generating and should not yet change practice.
Background: Mitral regurgitation (MR) carries adverse prognosis after myocardial infarction (MI). Acute ischemicMRremains under-investigated due to it’s often transient nature. Purpose: To assess left ventricular (LV) mechanics by speckle-tracking echocardiography (STE) in acute inferoposterior MI and ischemic MR. Methods: 34 patients withno or mildMR(NMRgroup), 35 patients with grade ≥2MR(IMR group), and 35 age and gender matched healthy subjects were enrolled into the study. Two-dimensional STE was performed within 48 hours of presentation and reperfusion therapy. Offline 2D STE analysis was performed with GE EchoPAC software. Statistical analysis was carried out with SPSS 21.0 statistics package. Results: LV ejection fraction and longitudinal deformation parameters were significantly better in healthy subjects, but did not differ between both study groups. All circumferential strains were significantly worse in IMR group compared to healthy subjects and NMR group. Radial strains were similar between control and NMR groups. However, global, basal and mid-ventricular radial strain values were significantly lower in IMR group. Conclusion: Ischemic MR in acute inferoposterior MI is associated with impaired radial and circumferential myocardial deformation assessed by 2D STE. Abstract P511 Table. Control group A, n=35 NMR group B, n=34 IMR group C, n=35 A vs B A vsC B vsC LVEF (%) 59.8+6.8 51.6+7.2 51.5+9.2 ,0.001 ,0.001 1.0 GLS (%) -21.1+1.7 -17.9+2.5 -17.6+2.7 ,0.001 ,0.001 0.6 GCS (%) -17.9+3.1 -17.6+7.9 -13.4+3.4 0.03 ,0.001 0.001 BCS (%) -17.1+3.5 -14.5+3.9 -12.7+3.3 0.001 ,0.001 0.04 MCS (%) -18.4+3.4 -15.9+3.9 +-13.7+3.9 0.003 ,0.001 0.03 ACS (%) -18.3+4.7 -18.9+4.9 -14.2+4.9 0.5 0.001 ,0.001 GRS (%) 37.9+11.5 37.1+12.1 28.1+12.9 0.6 0.001 ,0.001 BRS (%) 33.2+13.6 35.9+13.0 25.9+21.8 0.5 0.04 0.03 MRS (%) 46.2+21.4 41.0+18.1 30.7+15.7 0.3 0.002 0.02 ARS (%) 32.8+19.0 33.3+21.0 27.5+20.0 1.0 0.2 0.3 NMR - no
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Bucciarelli et al. (2015) studied this question.
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