title: Prognostic significance of mild mitral regurgitation by color Doppler echocardiography in acute myocardial infarction.
abstract: Mitral regurgitation (MR) complicating acute myocardial infarction (AMI) is associated with increased mortality. The prognostic significance of only mild MR detected by echocardiography in patients with AMI is unknown. This study assessed the long-term risk associated with mild MR detected by color Doppler echocardiography within the first 48 hours of admission in 417 consecutive patients with AMI. No MR was detected in 271 patients (65%), mild MR was seen in 121 patients (29%), and moderate or severe MR was noted in 25 patients (6%). One-year mortality rates were 4.8%, 12.4%, and 24%, respectively (p<0.001). Multivariate analysis revealed that mild MR was independently associated with increased 1-year mortality (p<0.05) after adjustment for age, gender, previous myocardial infarction, diabetes mellitus, systemic hypertension, Killip grade > or =2 on admission, and left ventricular ejection fraction < or =40%. The hazard ratio for 1-year mortality was 2.31 (95% confidence interval 1.03 to 5.20) for mild MR and 2.85 (95% confidence interval 0.95 to 8.51) for moderate or severe MR. Thus, mild MR detected by color Doppler echocardiography within the first 2 days of admission in patients with AMI is a significant independent risk predictor for 1-year all-cause mortality.
authors.affiliation: Chaim Sheba Medical Center, Tel Hashomer, Israel. feinberg@netvision.net.il
authors.forename: M S
authors.initials: MS
authors.lastname: Feinberg
authors.forename: E
authors.initials: E
authors.lastname: Schwammenthal
authors.forename: L
authors.initials: L
authors.lastname: Shlizerman
authors.forename: A
authors.initials: A
authors.lastname: Porter
authors.forename: H
authors.initials: H
authors.lastname: Hod
authors.forename: D
authors.initials: D
authors.lastname: Friemark
authors.forename: S
authors.initials: S
authors.lastname: Matezky
authors.forename: V
authors.initials: V
authors.lastname: Boyko
authors.forename: L
authors.initials: L
authors.lastname: Mandelzweig
authors.forename: Z
authors.initials: Z
authors.lastname: Vered
authors.forename: S
authors.initials: S
authors.lastname: Behar
authors.forename: A
authors.initials: A
authors.lastname: Sagie
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging*; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging* / Q000401:mortality; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate