Functional Mitral Regurgitation Predicts Prognosis Independent of Left Ventricular Systolic and Diastolic Indices in Patients with Ischemic Heart Disease
Section snippets
Study Populations
Between January 2000 and December 2004, patients with ischemic heart disease who were referred to the echocardiographic examination, including tissue Doppler imaging analysis, were consecutively included. There were 524 consecutive patients with ischemic heart disease (361 male and 163 female with a mean age of 69 years). Ischemic heart disease included angina pectoris, myocardial infarction, and silent myocardial ischemia. Angina pectoris included symptomatic stable or unstable angina patients
Results
During the follow-up period (average 615 ± 372 days), 63 deaths (11.6%) were recorded (31 cardiac deaths and 32 noncardiac deaths, respectively).
The clinical characteristics are shown in Table 1. FMR was diagnosed as none or mild in 203 patients, moderate in 263 patients, and severe in 58 patients. Patients with severe FMR were older and had a higher incidence of a history of congestive heart failure (both P < .01). There were no significant differences in the incidence of coronary risk factors
Discussion
Our study shows that the presence of FMR, increased E/E’, representing an elevated left ventricular filling pressure, and decreased EF were all strong independent predictors of clinical outcome in patients with a broad spectrum of ischemic heart disease.
Invasive and noninvasive evaluations of mitral regurgitation have been shown to predict late outcome in patients with myocardial infarction.1, 2, 3, 4, 5 The Survival and Ventricular Enlargement study, which included 727 patients postmyocardial
Study Limitations
There are several limitations in this study. First, although consecutive patients were enrolled in this study, this study may be weakened by the fact that this was a small, retrospective, single-center study. Second, quantitative analysis of the mitral regurgitation using either effective regurgitant orifice area or regurgitant volume has not been used to stratify patients. Therefore, incremental value of the FMR grade in this study population is unknown. Despite this limitation, it is notable
Conclusion
Severe FMR and E/E’, and left ventricular EF are strong and independent echocardiographic predictors of mortality and morbidity in patients with ischemic heart disease.
References (37)
- et al.
Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction
Am J Cardiol
(2000) - et al.
Contribution of ischemic mitral regurgitation to congestive heart failure after myocardial infarction
J Am Coll Cardiol
(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.
Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation
J Am Coll Cardiol
(2001) - et al.
Quantitation of mitral valve tenting in ischemic mitral regurgitation by transthoracic real-time three-dimensional echocardiography
J Am Coll Cardiol
(2005) - et al.
Long-term prognostic significance of left atrial volume in acute myocardial infarction
J Am Coll Cardiol
(2004) - et al.
Left ventricular dilatationPrognostic value in severe left ventricular dysfunction secondary to coronary artery disease
Chest
(1985) - et al.
Left ventricular ejection fraction to predict early mortality in patients with non-ST-segment elevation acute coronary syndromes
Am Heart J
(2005) - et al.
Wall motion score index and ejection fraction for risk stratification after acute myocardial infarction
Am Heart J
(2006) - et al.
Prognostic implications of restrictive left ventricular filling in acute myocardial infarction: a serial Doppler echocardiographic study
J Am Coll Cardiol
(1997)