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Long-term prognostic value of mitral regurgitation in acute coronary syndromes
  1. Anita Persson1,
  2. Marianne Hartford2,
  3. Johan Herlitz2,
  4. Thomas Karlsson2,
  5. Torbjørn Omland3,4,
  6. Kenneth Caidahl1,5
  1. 1Department of Clinical Physiology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden
  2. 2Department of Cardiology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden
  3. 3Department of Medicine, Akershus University Hospital, Lørenskog, Norway
  4. 4University of Oslo, Oslo, Norway
  5. 5Department of Clinical Physiology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Professor Kenneth Caidahl, Department of Clinical Physiology and Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden; kenneth.caidahl{at}


Objectives To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS).

Design Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA.

Setting Single-centre university hospital.

Patients 725 patients with ACS.

Main outcome measures Death and readmission for congestive heart failure.

Results During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003).

Conclusions MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.

  • Acute coronary syndromes
  • acute myocardial infarction
  • angina pectoris
  • B-type natriuretic peptide
  • echocardiography
  • mitral regurgitation
  • risk stratification
  • mitral regurgitation

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  • Funding The study was supported by the Swedish Research Council (14231), the Swedish Heart Lung Foundation, the Västra Götaland Region, the Vardal Foundation, Gothenburg University and the Gothenburg Medical Society.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the ethics committee at Gothenburg University.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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