Key result
Over 4 years following an acute STEMI, the mitral valve annulus became progressively flatter with a mean decrease in annular height of 0.19 cm, alongside significant reductions in tenting height and area.
Why the study?
Mechanisms contributing to ischaemic mitral regurgitation in acute MI differ from chronic IMR, but little is known about dynamic changes in mitral valve geometry over time after acute MI.
Observational (n=30)
No
Mean Difference: 0.19
Absolute Event Rate: 0.69% vs 0.88%
p-value: p=<0.05
Mitral valve geometry undergoes dynamic changes over 4 years following a first STEMI, characterized by annulus flattening and improved tenting, independent of ischemic mitral regurgitation severity.
MV geometry remodels years after STEMI with annulus flattening and less tenting even without severe IMR; leaves open clinical relevance and requires prospective outcome studies.
Background: Recent data suggest that the mechanisms contributing to ischaemic mitral regurgitation (IMR) in the setting of acute myocardial infarction (MI) are different compared to chronic IMR.However, little is known about the dynamic changes over time of mitral valve (MV) geometry after acute MI.Methods and results: Comprehensive three-dimensional (3D) assessment of the MV geometry was performed in 30 patients in the fi rst 7 days after a fi rst ST elevation myocardial infarction (STEMI), and after 4 years of follow-up.The MV annulus diameters and area remained unchanged over time, however the MA became progressively flatter (mean difference of annular height 0.19±0.33cm, p<0.05), independently of the presence or severity of IMR.The posterior leaflet length and area got smaller over time (1.53±0.51cm vs 1.27±0.33cm; p<0.05 and 5.65±1.58cm 2 vs 4.88±1.65 cm 2 ; p<0.05, respectively).The tenting height and area were smaller at follow-up (9.06±2.6 mm vs 7.84±2.61mm, p<0.05; and 1.88±0.6cm 2 vs 1.57±0.5 cm 2 ; p<0.05, respectively).A larger tenting at follow-up correlated with 3D left atrial (LA) volumes, but not with LV volumes and ejection fraction.Conclusions: MV geometry changes over time even in patients with non-severe IMR.The MV healing process consists in annulus flattening associated with improved tenting.
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Onciul et al. (2019) conducted an observational in Acute ST-elevation myocardial infarction (STEMI) (n=30). Time post-myocardial infarction (4 years follow-up) vs. Baseline (first 7 days after STEMI) was evaluated on Mitral annulus height (cm) (MD 0.19 cm, p=<0.05). Over 4 years following an acute STEMI, the mitral valve annulus became progressively flatter with a mean decrease in annular height of 0.19 cm, alongside significant reductions in tenting height and area.
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