Significance of a mitral regurgitation systolic murmur complicating a first acute myocardial infarction in the coronary care unit -- assessment by colour Doppler flow imaging

To determine the prevalence and significance of a systolic mitral murmur heard after a first acute myocardial infarction (MI), we studied 186 consecutive patients in the coronary care unit (CCU) during a one-year period. Fifteen patients had a murmur as a result of mitral regurgitation (MR) (prevalence 8%) documented by colour Doppler flow imaging. It was heard before the third day of hospitalization in 10 (67%) patients, and on the third day itself in the remainder. The severity of MR was graded semi-quantitatively: moderate in 12 (80%) patients, and mild, moderate to severe and severe in three respectivety. The direction of the MR jet, determined by colour flow imaging, improved the information obtained by two-dimensional echocardiography (2D echo) that could only diagnose mitral leaflet abnormality in seven (47%) patients. in 10 of 15 (67%) patients, the 2D echo ejection fraction was ≥40% and in eight (53%) the wall motion score obtained by analysing 11 left ventricular (LV) segments was 8. Two (13%) patients died in tile CCU, four (27%) had LV failure, one angina and eight (53%) remained asymptomaric in the hospital. Of 171 patients without a systolic murmur, 22 (13%) had LV failure, 13 (8%) angina and 25 (15%) died during the in-hospital stay (P-NS for these complications between patients with and without MR murmur). During a follow-up of 12–24 months, one MR patient died, and seven (47%) remained asymptomatic. We conclude that the prevalence of MR systolic murmurs in acute MI patients is low. The LV function and the prognosis of a majority of these patients is rather good.