Left ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction–optimal timing for echocardiographic imaging.
Abstract: Although mitral regurgitation (MR) has been associated with an increased risk of death and heart failure after myocardial infarction (MI), the relationship between post-MI MR and left ventricular (LV) remodeling has not been entirely clarified. In addition, the optimal timing for assessing MR after MI remains unknown. Methods: Post-MI MR was assessed by Doppler echocardiography at hospital discharge (baseline) and after 3 months in 261 patients with an inaugural anterior MI. We studied LV remodeling during a 1-year period and clinical follow-up after 3 years, according to MR severity at baseline and at 3 months. Results: Left ventricular remodeling was demonstrated as an increase in LV end-diastolic volume from 56 +/- 15 mL/m(2) at baseline to 63 +/- 19 mL/m(2) at 1 year (P 20% increase in LV end-diastolic volume between baseline and 1 year according to MR severity at 3 months (no MR: 21%, mild MR: 32%, moderate/severe MR: 60%) (P = .008). Both MR at baseline and at 3 months were associated with death or rehospitalization for heart failure by univariate analysis (P = .014 and P < .0001, respectively). By multivariable analysis, MR at baseline was not an independent predictor of adverse outcome (P = .66). By contrast, MR at 3 months was independently associated with adverse outcome with a hazard ratio of 2.23 (1.02-4.91 [P = .04]). Conclusions: After an inaugural anterior MI, MR is associated with LV remodeling and adverse clinical outcome. For prognostic purpose, the optimal timing for assessing MR is the chronic post-MI stage rather than the early post-MI period.
Publication Date: 2008-02-21 PubMed ID: 18440348DOI: 10.1016/j.ahj.2007.12.007Google Scholar: Lookup
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- Journal Article
- Multicenter Study
- Research Support
- Non-U.S. Gov't
Summary
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The research article explores the relationship between mitral regurgitation (MR), a heart condition where blood leaks backward through the mitral valve, and the remodeling of the left ventricle (LV), a process that alters the size, shape, and function of the heart following a heart attack. It suggests that the severity of MR three months after a heart attack is linked with changes to the LV, informing patient prognosis. The study proposes that timing is crucial in assessing MR for treatment decisions.
Research Methodology
- The study drew from a sample of 261 patients who had experienced a first (inaugural) anterior myocardial infarction (MI), or heart attack.
- Researchers scrutinized MR and evaluated LV remodeling in these patients over a year.
- Their clinical progress and any notable medical adverse events were tracked for three years.
Findings and Analysis
- Notably, the average LV end-diastolic volume, a measure of the size of the heart’s chambers, increased from baseline to one year after the heart attack.
- The severity of MR at discharge was not significantly associated with LV remodeling. However, the severity of MR after three months was noted as a strong predictor of ensuing LV changes.
- The study found that the greater the severity of MR at the three-month mark, the higher the likelihood of patients experiencing significant LV changes between baseline and one year.
- Both immediate and three-month MR assessments were associated with death or readmission for heart failure, indicating the potential for adverse outcomes.
- Upon multi-variable analysis, MR severity at baseline wasn’t an independent predictor of adverse outcomes, while three-month MR held up as a risk factor, solidifying the significance of the timing of assessment.
Summary of Key Conclusions
- The research reveals that MR after an inaugural anterior MI is linked to LV remodeling and negative clinical outcomes, indicating its potential utility as a prognostic marker.
- Importantly, for the purpose of predicting prognosis and guiding treatment, assessing MR is best delayed to the chronic post-MI stage, rather than conducted immediately after a heart attack.
Cite This Article
APA
Ennezat PV, Darchis J, Lamblin N, Tricot O, Elkohen M, Aumégeat V, Equine O, Dujardin X, Saadouni H, Le Tourneau T, de Groote P, Bauters C.
(2008).
Left ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction–optimal timing for echocardiographic imaging.
Am Heart J, 155(5), 959-965.
https://doi.org/10.1016/j.ahj.2007.12.007 Publication
Researcher Affiliations
- Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
MeSH Terms
- Adult
- Echocardiography, Doppler
- Female
- Humans
- Male
- Middle Aged
- Mitral Valve Insufficiency / diagnostic imaging
- Mitral Valve Insufficiency / etiology
- Mitral Valve Insufficiency / physiopathology
- Myocardial Infarction / complications
- Myocardial Infarction / diagnostic imaging
- Severity of Illness Index
- Time Factors
- Ventricular Remodeling / physiology
Citations
This article has been cited 4 times.- Klug G, Feistritzer HJ, Reinstadler SJ, Reindl M, Tiller C, Holzknecht M, Mayr A, Müller S, Bauer A, Metzler B. Impact of posteromedial papillary muscle infarction on mitral regurgitation during ST-segment elevation myocardial infarction.. Int J Cardiovasc Imaging 2020 Mar;36(3):503-511.
- Khaled S, Matahen R. Cardiovascular risk factors profile in patients with acute coronary syndrome with particular reference to left ventricular ejection fraction.. Indian Heart J 2018 Jan-Feb;70(1):45-49.
- Chinitz JS, Chen D, Goyal P, Wilson S, Islam F, Nguyen T, Wang Y, Hurtado-Rua S, Simprini L, Cham M, Levine RA, Devereux RB, Weinsaft JW. Mitral apparatus assessment by delayed enhancement CMR: relative impact of infarct distribution on mitral regurgitation.. JACC Cardiovasc Imaging 2013 Feb;6(2):220-34.
- Persson A, Hartford M, Herlitz J, Karlsson T, Omland T, Caidahl K. Long-term prognostic value of mitral regurgitation in acute coronary syndromes.. Heart 2010 Nov;96(22):1803-8.
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