(Circulation. 2001;103:1759.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Ischemic Mitral Regurgitation
Long-Term Outcome and Prognostic Implications With Quantitative Doppler Assessment
From the Division of Cardiovascular Diseases and Internal Medicine (F.G., M.E.-S., A.J.T.), the Division of Cardiovascular Surgery (K.J.Z.), and the Section of Biostatistics (K.R.B.), Mayo Clinic, Rochester, Minn.
Background—Myocardial infarction (MI) can directly cause ischemic mitral regurgitation (IMR), which has been touted as an indicator of poor prognosis in acute and early phases after MI. However, in the chronic post-MI phase, prognostic implications of IMR presence and degree are poorly defined.
Methods and Results—We
analyzed 303 patients with previous (>16 days) Q-wave MI by ECG who
underwent transthoracic echocardiography: 194 with IMR quantitatively
assessed in routine practice and 109 without IMR matched for baseline
age (71±11 versus 70±9 years,
P=0.20), sex, and ejection
fraction (EF, 33±14% versus 34±11%,
P=0.14). In IMR patients,
regurgitant volume (RVol) and effective regurgitant orifice (ERO) area
were 36±24 mL/beat and 21±12 mm2,
respectively. After 5 years, total mortality and cardiac mortality for
patients with IMR (62±5% and 50±6%, respectively) were higher than
for those without IMR (39±6% and 30±5%, respectively) (both
P<0.001). In multivariate
analysis, independently of all baseline characteristics, particularly
age and EF, the adjusted relative risks of total and cardiac mortality
associated with the presence of IMR (1.88,
P=0.003 and 1.83,
P=0.014, respectively) and
quantified degree of IMR defined by RVol 
30 mL (2.05,
P=0.002 and 2.01,
P=0.009) and by ERO 20
mm2 (2.23,
P=0.003 and 2.38,
P=0.004) were
high.
Conclusions—In the chronic phase after MI, IMR presence is associated with excess mortality independently of baseline characteristics and degree of ventricular dysfunction. The mortality risk is related directly to the degree of IMR as defined by ERO and RVol. Therefore, IMR detection and quantification provide major information for risk stratification and clinical decision making in the chronic post-MI phase.
Key Words: infarction • mitral valve • prognosis • regurgitation
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L. Perez de Isla, J. Zamorano, M. Quezada, C. Almeria, J. L. Rodrigo, V. Serra, J. C. Garcia Rubira, A. F. Ortiz, and C. Macaya Functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome: contribution to congestive heart failure Eur. Heart J., December 1, 2007; 28(23): 2866 - 2872. [Abstract] [Full Text] [PDF]
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C. Ypenburg, P. Lancellotti, L. F. Tops, G. B. Bleeker, E. R. Holman, L. A. Pierard, M. J. Schalij, and J. J. Bax Acute Effects of Initiation and Withdrawal of Cardiac Resynchronization Therapy on Papillary Muscle Dyssynchrony and Mitral Regurgitation J. Am. Coll. Cardiol., November 20, 2007; 50(21): 2071 - 2077. [Abstract] [Full Text] [PDF]
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L. P. Ryan, B. M. Jackson, L. M. Parish, H. Sakamoto, T. J. Plappert, M. St. John-Sutton, J. H. Gorman III, and R. C. Gorman Mitral Valve Tenting Index for Assessment of Subvalvular Remodeling Ann. Thorac. Surg., October 1, 2007; 84(4): 1243 - 1249. [Abstract] [Full Text] [PDF]
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J. Hung, M. Chaput, J. L. Guerrero, M. D. Handschumacher, L. Papakostas, S. Sullivan, J. Solis, and R. A. Levine Persistent Reduction of Ischemic Mitral Regurgitation by Papillary Muscle Repositioning: Structural Stabilization of the Papillary Muscle Ventricular Wall Complex Circulation, September 11, 2007; 116(11_suppl): I-259 - I-263. [Abstract] [Full Text] [PDF]
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R. Beeri, C. Yosefy, J. L. Guerrero, S. Abedat, M. D. Handschumacher, R. E. Stroud, S. Sullivan, M. Chaput, D. Gilon, G. J. Vlahakes, et al. Early Repair of Moderate Ischemic Mitral Regurgitation Reverses Left Ventricular Remodeling: A Functional and Molecular Study Circulation, September 11, 2007; 116(11_suppl): I-288 - I-293. [Abstract] [Full Text] [PDF]
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F. Roshanali, M. H. Mandegar, M. A. Yousefnia, H. Rayatzadeh, and F. Alaeddini A Prospective Study of Predicting Factors in Ischemic Mitral Regurgitation Recurrence After Ring Annuloplasty Ann. Thorac. Surg., September 1, 2007; 84(3): 745 - 749. [Abstract] [Full Text] [PDF]
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G. D'Ancona, G. Mamone, G. Marrone, F. Pirone, G. Santise, S. Sciacca, and M. Pilato Ischemic mitral valve regurgitation: the new challenge for magnetic resonance imaging Eur. J. Cardiothorac. Surg., September 1, 2007; 32(3): 475 - 480. [Abstract] [Full Text] [PDF]
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L. Menicanti, S. Castelvecchio, M. Ranucci, A. Frigiola, C. Santambrogio, C. de Vincentiis, J. Brankovic, and M. Di Donato Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 433 - 441. [Abstract] [Full Text] [PDF]
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T. Mihaljevic, B.-K. Lam, J. Rajeswaran, M. Takagaki, M. S. Lauer, A. M. Gillinov, E. H. Blackstone, and B. W. Lytle Impact of Mitral Valve Annuloplasty Combined With Revascularization in Patients With Functional Ischemic Mitral Regurgitation J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2191 - 2201. [Abstract] [Full Text] [PDF]
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M. A. Borger, P. M. Murphy, A. Alam, S. Fazel, M. Maganti, S. Armstrong, V. Rao, and T. E. David Initial results of the chordal-cutting operation for ischemic mitral regurgitation J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1483 - 1492. [Abstract] [Full Text] [PDF]
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L. A Pierard and P. Lancellotti Stress testing in valve disease Heart, June 1, 2007; 93(6): 766 - 772. [Full Text] [PDF]
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J. Kwan, M. A. Gillinov, J. D. Thomas, and T. Shiota Geometric predictor of significant mitral regurgitation in patients with severe ischemic cardiomyopathy, undergoing Dor procedure: A real-time 3D echocardiographic study Eur J Echocardiogr, June 1, 2007; 8(3): 195 - 203. [Abstract] [Full Text] [PDF]
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L. Ryan, B. Jackson, L. Parish, H. Sakamoto, T. Plappert, M. St. J. Sutton, J. Gorman III, and R. Gorman Quantification and localization of mitral valve tenting in ischemic mitral regurgitation using real-time three-dimensional echocardiography Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 839 - 844. [Abstract] [Full Text] [PDF]
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U. Sartipy, A. Albage, E. Mattsson, and D. Lindblom Edge-to-Edge Mitral Repair Without Annuloplasty in Combination With Surgical Ventricular Restoration Ann. Thorac. Surg., April 1, 2007; 83(4): 1303 - 1309. [Abstract] [Full Text] [PDF]
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M. Fukuoka, M. Nonaka, S. Masuyama, T. Shimamoto, K. Tambara, H. Yoshida, T. Ikeda, and M. Komeda Chordal "translocation" for functional mitral regurgitation with severe valve tenting: An effort to preserve left ventricular structure and function J. Thorac. Cardiovasc. Surg., April 1, 2007; 133(4): 1004 - 1011. [Abstract] [Full Text] [PDF]
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J. Magne, P. Pibarot, F. Dagenais, Z. Hachicha, J. G. Dumesnil, and M. Senechal Preoperative Posterior Leaflet Angle Accurately Predicts Outcome After Restrictive Mitral Valve Annuloplasty for Ischemic Mitral Regurgitation Circulation, February 13, 2007; 115(6): 782 - 791. [Abstract] [Full Text] [PDF]
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M. Pocar, A. Moneta, A. Grossi, and F. Donatelli Coronary Artery Bypass for Heart Failure in Ischemic Cardiomyopathy: 17-Year Follow-Up Ann. Thorac. Surg., February 1, 2007; 83(2): 468 - 474. [Abstract] [Full Text] [PDF]
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L. Perez de Isla, J. Zamorano, M. Quezada, C. Almeria, J. L. Rodrigo, V. Serra, J. C. Garcia Rubira, A. F. Ortiz, and C. Macaya Prognostic significance of functional mitral regurgitation after a first non-ST-segment elevation acute coronary syndrome Eur. Heart J., November 2, 2006; 27(22): 2655 - 2660. [Abstract] [Full Text] [PDF]
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