Clinical InvestigationValvular and Congenital Heart DiseaseLeft ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction—Optimal timing for echocardiographic imaging
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.
References (20)
- et al.
Mitral regurgitation after myocardial infarction: a review
Am J Med
(2006) - et al.
Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction
J Am Coll Cardiol
(2005) - et al.
Left ventricular remodeling after anterior wall acute myocardial infarction in modern clinical practice (from the REmodelage VEntriculaire [REVE] study group)
Am J Cardiol
(2006) - et al.
A prospective evaluation of left ventricular remodeling after inaugural anterior myocardial infarction as a function of gene polymorphisms in the renin-angiotensin-aldosterone, adrenergic, and metalloproteinase systems
Am J Heart
(2007) - et al.
New Doppler echocardiographic applications for the study of diastolic function
J Am Coll Cardiol
(1998) - et al.
Prognostic significance of echocardiographically defined mitral regurgitation early after acute myocardial infarction
Am Heart J
(2005) - et al.
Importance of mitral regurgitation inpatients undergoing percutaneous coronary intervention for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial
J Am Coll Cardiol
(2004) - et al.
Color flow imaging compared with quantitative Doppler assessment of severity of mitral regurgitation: influence of eccentricity of jet and mechanism of regurgitation
J Am Coll Cardiol
(1993) - et al.
Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation
Circulation
(2005) - et al.
Ischemic mitral regurgitation and risk of heart failure after myocardial infarction
Arch Intern Med
(2006)
Cited by (0)
This study was supported by the CHRU de Lille PHRC 2001R/1918 and the Fondation de France, Paris, France.