title: Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation.
abstract: BACKGROUND
  In case series, mitral regurgitation (MR) increased the risk of death after myocardial infarction (MI), yet the prevalence of MR, its incremental prognostic value over ejection fraction (EF), and its association with heart failure and death after MI in the community is not known.
  
  
  RESULTS
  The prevalence of MR and its association with heart failure and death were examined among 1331 patients within a geographically defined MI incidence cohort between 1988 and 1998. Echocardiography was performed within 30 days after MI in 773 patients (58%), and MR was present in 50% of cases, mild in 38%, and moderate or severe in 12%. Among patients with MR, a murmur was inconsistently detected clinically. After 4.7+/-3.3 years of follow-up, 109 episodes of heart failure and 335 deaths occurred. There was a graded positive association between the presence and severity of MR and heart failure or death. Moderate or severe MR was associated with a large increase in the risk of heart failure (relative risk 3.44, 95% CI 1.74 to 6.82, P<0.001) and death (relative risk 1.55, 95% CI 1.08 to 2.22, P=0.019) among 30-day survivors independent of age, gender, EF, and Killip class.
  
  
  CONCLUSIONS
  In the community, MR is frequent and often silent after MI. It carries information to predict heart failure or death among 30-day survivors independently of age, gender, EF, and Killip class. These findings, which are applicable to a large community-based MI cohort, suggest that the assessment of MR should be included in post-MI risk stratification.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn 55905, USA.
authors.forename: Francesca
authors.initials: F
authors.lastname: Bursi
authors.forename: Maurice
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: Vuyisile T
authors.initials: VT
authors.lastname: Nkomo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
authors.forename: Susan A
authors.initials: SA
authors.lastname: Weston
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Meverden
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality; D015995:Prevalence; D011379:Prognosis; D012111:Residence Characteristics; D012306:Risk; D013318:Stroke Volume; D016019:Survival Analysis; D016277:Ventricular Function, Left