Clinical Investigation
Valvular and Congenital Heart Disease
Left ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction—Optimal timing for echocardiographic imaging

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Background

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/m2 at baseline to 63 ± 19 mL/m2 at 1 year (P < .0001). MR severity at baseline was not significantly associated with LV remodeling. By contrast, MR severity at 3 months was a strong indicator of LV remodeling. There was a graded increase in the proportion of patients with a >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.

Section snippets

Study population

REVE was a multicenter prospective study investigating the incidence and determinants of LV remodeling after an inaugural acute anterior Q-wave MI.10, 11 Patients were considered eligible if the infarct zone comprised at least 3 LV segments that were akinetic at predischarge echocardiography. Exclusion criteria were: inadequate echographic image quality, age >85 years, life-limiting noncardiac disease, prior Q-wave MI, and patients who had scheduled coronary bypass graft. Patients with primary

Results

The baseline characteristics of the study population are shown in Table I. Most of the 261 patients were men, and the mean age was 58 ± 14 years. Initial reperfusion therapy was thrombolysis in 54% of the cases and primary angioplasty in 29% of the cases; 17% of patients had no reperfusion therapy. Coronary angiography during hospitalization was almost systematic (99%). Overall (taking into account procedures performed as the initial reperfusion strategy and delayed procedures before hospital

Discussion

The present data obtained in patients with an inaugural anterior MI indicate that (1) Doppler-detected MR is frequent despite a high rate of reperfusion and almost systematic use of angiotensin-converting enzyme inhibitors and β-blockers, (2) post-MI MR diagnosed at 3 months—but not at baseline—is associated with LV remodeling, (3) post-MI MR diagnosed at 3 months—but not at baseline—is an independent predictor of clinical outcome.

Conclusions

After an inaugural MI, MR is associated with LV remodeling and adverse clinical outcome. In these patients, for prognostic purpose, the optimal timing for assessing MR is the chronic post-MI stage rather than the early post-MI period.

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This study was supported by the CHRU de Lille PHRC 2001R/1918 and the Fondation de France, Paris, France.

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