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The characteristics of mitral regurgitation: Data from patients admitted following acute myocardial infarction
Harish Sharma1,2, Ashwin Radhakrishnan2, Peter Nightingale3
1Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.
Insights
This study found that mitral regurgitation (MR) is common after myocardial infarction (MI). Age and reduced left ventricular ejection fraction (LVEF) are key predictors of mortality in these patients.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Medicine
Background:
- Myocardial infarction (MI) can lead to complications affecting heart valve function.
- Mitral regurgitation (MR) is a potential consequence of acute MI, impacting patient prognosis.
- Understanding the prevalence and characteristics of MR post-MI is crucial for patient management.
Purpose of the Study:
- To determine the prevalence and severity of mitral regurgitation (MR) following acute myocardial infarction (MI).
- To assess the characteristics of MR, including leaflet thickness and annular calcification.
- To identify factors associated with mortality in patients with MR post-MI.
Main Methods:
- Retrospective analysis of prospectively collected data from patients with type-1 MI treated with percutaneous intervention.
- Transthoracic echocardiography used for MR assessment, employing multiparametric quantification (PISA, VC, EROA, RVol).
- Cox proportional hazards univariate and multivariate analyses to identify predictors of mortality.
Main Results:
- MR was observed in 29.4% of patients (294/1000), with mild MR in 76%, moderate in 21%, and severe in 3%.
- Quantification of MR severity was performed in a subset of patients, with higher rates for moderate/severe MR.
- Factors associated with mortality included age, creatinine clearance, LVEF, LVEDVi, LVESVi, left atrial volume, and pulmonary hypertension likelihood. Age and LVEF were independent predictors.
Conclusions:
- Mitral regurgitation is a frequent complication after acute myocardial infarction.
- Specific echocardiographic parameters and clinical factors are associated with increased mortality in patients with MR post-MI.
- Age and left ventricular ejection fraction are independent predictors of mortality in this patient cohort.
Abstract:
Data were collected on patients admitted to the Queen Elizabeth Hospital Birmingham with type-1 myocardial infarction during 2016 and 2017 inclusively, who were treated by percutaneous intervention and had pre-discharge transthoracic echocardiography. The data were obtained from prospectively maintained hospital databases and records. Echocardiography was performed and reported contemporaneously by accredited echocardiographers. The purpose was to understand the prevalence and characteristics of mitral regurgitation (MR) after acute MI, including patients with ST-elevation (STEMI) and non-ST elevation MI (NSTEMI). MR was observed in 294/1000 patients with the following relative severities: mild = 76%, moderate = 21%, severe = 3% [1]. MR was graded by multiparametric quantification including proximal isolvelocity surface area (PISA), vena contracta (VC), effective regurgitant orifice area (EROA) and regurgitant volume (RVol). Amongst all patients with MR (n=294), PISA was performed in 89/294 (30%), VC 75/294 (26%), EROA in 53/294 (18%) and RVol in 26/294 (9%). Amongst patients with moderate or severe MR (n=70), PISA was performed in 57/70 (81%), VC in 55/70 (79%), EROA in 46/70 (66%) and RVol in 25/70 (36%). Characteristics of MR following acute MI were also assessed including frequency of reported leaflet thickness (259/294 = 88%) and mitral annular calcification (102/294 = 35%). Furthermore, the effect of MI on pre-existing MR was investigated and patients with pre-existing MR who continue to have MR after acute MI were found to have progression of MR by one grade in approximately 25% of cases. Finally, using Cox proportional hazards univariate analysis, significant factors associated with mortality in patients with MR post-MI include age (HR 1.065; 95% CI 1.035-1.096; p<0.001), creatinine clearance, (HR 0.981; 95% CI 0.971-0.991; p<0.001), left ventricular ejection fraction (LVEF) (HR 0.966; 95% CI 0.948-0.984; p<0.001), indexed left ventricular end-diastolic volume (LVEDVi) (HR 1.016; 95% CI 1.003-1.029; p=0.018), indexed left ventricular end-systolic volume (LVESVi) (HR 1.021; 95% CI 1.008-1.034; p=0.001), indexed left atrial volume (HR 1.026; 95% CI 1.012-1.039; p<0.001), and those with intermediate likelihood of pulmonary hypertension (pHTN) (HR 2.223; 95% CI 1.126-4.390; p=0.021); or high likelihood of pHTN (HR 5.626; 95% CI 2.189-14.461; p<0.001). Age and LVEF were found to be independent predictors of mortality on multivariate analysis [1].
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