Document Detail


Mechanisms and predictors of mitral regurgitation after high-risk myocardial infarction.
MedLine Citation:
PMID:  22305962     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Mitral regurgitation (MR) has been associated with adverse outcomes after myocardial infarction (MI). Without structural valve disease, functional MR has been related to left ventricular (LV) remodeling and geometric deformation of the mitral apparatus. The aims of this study were to elucidate the mechanistic components of MR after high-risk MI and to identify predictors of MR progression during follow-up.
METHODS: The Valsartan in Acute Myocardial Infarction Echo substudy prospectively enrolled 610 patients with LV dysfunction, heart failure, or both after MI. MR at baseline, 1 month, and 20 months was quantified by mapping jet expansion in the left atrium in 341 patients with good-quality echocardiograms. Indices of LV remodeling, left atrial size, and diastolic function and parameters of mitral valve deformation, including tenting area, coaptation depth, anterior leaflet concavity, annular diameters, and contractility, were assessed and related to baseline MR. The progression of MR was further analyzed, and predictors of worsening among the baseline characteristics were identified.
RESULTS: Tenting area, coaptation depth, annular dilatation, and left atrial size were all associated with the degree of baseline MR. Tenting area was the only significant and independent predictor of worsening MR; a tenting area of 4 cm(2) was a useful cutoff to identify worsening of MR after MI and moderate to severe MR after 20 months.
CONCLUSIONS: Increased mitral tenting and larger mitral annular area are determinants of MR degree at baseline, and tenting area is an independent predictor of progression of MR after MI. Although LV remodeling itself contributes to ischemic MR, this influence is directly dependent on alterations in mitral geometry.
Authors:
Alessandra Meris; Maria Amigoni; Anil Verma; Jens Jakob Thune; Lars Køber; Eric Velazquez; John J V McMurray; Marc A Pfeffer; Robert Califf; Robert A Levine; Scott D Solomon;
Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-02-04
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  25     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-04-24     Completed Date:  2012-08-30     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  535-42     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
Affiliation:
Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Aged
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Captopril / therapeutic use
Disease Progression
Echocardiography, Doppler, Color / methods*
Electrocardiography / methods
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mitral Valve Insufficiency / epidemiology,  etiology,  ultrasonography*
Monitoring, Physiologic / methods
Multivariate Analysis
Myocardial Infarction / complications*,  diagnosis,  drug therapy*
Predictive Value of Tests
Prospective Studies
ROC Curve
Reference Values
Reproducibility of Results
Risk Assessment
Severity of Illness Index
Sex Factors
Statistics, Nonparametric
Stroke Volume / physiology
Tetrazoles / therapeutic use
Time Factors
Valine / analogs & derivatives,  therapeutic use
Ventricular Dysfunction, Left / epidemiology,  etiology,  ultrasonography
Ventricular Remodeling / physiology
Grant Support
ID/Acronym/Agency:
K24 HL067434/HL/NHLBI NIH HHS; R01 HL072265/HL/NHLBI NIH HHS; R01 HL109506/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Tetrazoles; 137862-53-4/valsartan; 62571-86-2/Captopril; 7004-03-7/Valine
Comments/Corrections

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