title: Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function.
abstract: OBJECTIVE
  Mitral regurgitation (MR) confers independent risk in patients with acute myocardial infarction. We utilized data from the VALsartan In Acute myocardial iNfarcTion echo study to relate baseline MR to left ventricular (LV) size, shape, and function, and to assess the relationship between baseline MR and progression of MR and cardiovascular (CV) outcomes.
  
  
  RESULTS
  We studied 496 patients with heart failure (HF) and/or systolic dysfunction after MI who underwent echocardiography at a median of 5 days after MI. MR severity, quantified as the regurgitant jet area/left atrial area ratio, was assessed at baseline, one and 20 months post-MI and related to LV size, shape, function, and clinical outcomes. Increased MR at baseline was associated with larger LV end-diastolic and end-systolic volumes, increased sphericity index, and reduced ejection fraction (P trend < 0.001). Moderate-severe MR was an independent predictor of total mortality [adjusted hazard ratio (HR) 2.4 (1.1-5.3)], CV mortality [adjusted HR 2.7 (1.2-6.1)], hospitalization for HF [adjusted HR 2.5 (1.1-5.5)], or death or HF hospitalization [adjusted HR 2.5 (1.4-4.6)]. Patients with progression of MR during the first post-MI month were substantially more likely to die or develop HF (adjusted HR per increased MR grade 3.0, 95% CI 1.8-4.9). Progression of MR over 20 months in survivors was associated with increased hospitalizations for HF (P < 0.001).
  
  
  CONCLUSIONS
  Following high-risk myocardial infarction, baseline mitral regurgitant severity is associated with larger LV volumes and worse LV function. Both baseline MR severity and progression of MR are associated with an increased likelihood of adverse outcomes.
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, USA. maria_amigoni@libero.it
authors.forename: Maria
authors.initials: M
authors.lastname: Amigoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Meris
authors.forename: Jens Jakob
authors.initials: JJ
authors.lastname: Thune
authors.forename: Deepa
authors.initials: D
authors.lastname: Mangalat
authors.forename: Hicham
authors.initials: H
authors.lastname: Skali
authors.forename: Mikhail
authors.initials: M
authors.lastname: Bourgoun
authors.forename: J Wayne
authors.initials: JW
authors.lastname: Warnica
authors.forename: Stale
authors.initials: S
authors.lastname: Barvik
authors.forename: J Malcolm O
authors.initials: JM
authors.lastname: Arnold
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Jalal
authors.initials: J
authors.lastname: Ghali
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D002306:Cardiac Volume / Q000502:physiology; D018450:Disease Progression; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000503:physiopathology; D009203:Myocardial Infarction / Q000209:etiology* / Q000503:physiopathology; D015588:Observer Variation; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000503:physiopathology; D020257:Ventricular Remodeling