title: Left ventricular remodeling is associated with the severity of mitral regurgitation after inaugural anterior myocardial infarction--optimal timing for echocardiographic imaging.
abstract: BACKGROUND
  Although mitral regurgitation (MR) has been associated with an increased risk of death and heart failure after myocardial infarction (MI), the relationship between post-MI MR and left ventricular (LV) remodeling has not been entirely clarified. In addition, the optimal timing for assessing MR after MI remains unknown.
  
  
  METHODS
  Post-MI MR was assessed by Doppler echocardiography at hospital discharge (baseline) and after 3 months in 261 patients with an inaugural anterior MI. We studied LV remodeling during a 1-year period and clinical follow-up after 3 years, according to MR severity at baseline and at 3 months.
  
  
  RESULTS
  Left ventricular remodeling was demonstrated as an increase in LV end-diastolic volume from 56 +/- 15 mL/m(2) at baseline to 63 +/- 19 mL/m(2) at 1 year (P < .0001). MR severity at baseline was not significantly associated with LV remodeling. By contrast, MR severity at 3 months was a strong indicator of LV remodeling. There was a graded increase in the proportion of patients with a >20% increase in LV end-diastolic volume between baseline and 1 year according to MR severity at 3 months (no MR: 21%, mild MR: 32%, moderate/severe MR: 60%) (P = .008). Both MR at baseline and at 3 months were associated with death or rehospitalization for heart failure by univariate analysis (P = .014 and P < .0001, respectively). By multivariable analysis, MR at baseline was not an independent predictor of adverse outcome (P = .66). By contrast, MR at 3 months was independently associated with adverse outcome with a hazard ratio of 2.23 (1.02-4.91 [P = .04]).
  
  
  CONCLUSIONS
  After an inaugural anterior MI, MR is associated with LV remodeling and adverse clinical outcome. For prognostic purpose, the optimal timing for assessing MR is the chronic post-MI stage rather than the early post-MI period.
authors.affiliation: Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
authors.forename: Pierre V
authors.initials: PV
authors.lastname: Ennezat
authors.forename: Julie
authors.initials: J
authors.lastname: Darchis
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.forename: Olivier
authors.initials: O
authors.lastname: Tricot
authors.forename: Mariam
authors.initials: M
authors.lastname: Elkohen
authors.forename: Valérie
authors.initials: V
authors.lastname: Aumégeat
authors.forename: Octave
authors.initials: O
authors.lastname: Equine
authors.forename: Xavier
authors.initials: X
authors.lastname: Dujardin
authors.forename: Hassan
authors.initials: H
authors.lastname: Saadouni
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: Pascal
authors.initials: P
authors.lastname: de Groote
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
mesh_terms: D000328:Adult; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D013997:Time Factors; D020257:Ventricular Remodeling / Q000502:physiology*