Long-term prognostic value of mitral regurgitation in acute coronary syndromes.
OBJECTIVE
To determine the additional prognostic value of mitral regurgitation (MR) over B-type natriuretic peptide (BNP), left ventricular ejection fraction (LVEF) and clinical characteristics in patients with acute coronary syndromes (ACS).


METHODS
Long-term follow-up in a prospective ACS cohort with Doppler-assessed MR, echocardiographically-determined LVEF and plasma BNP levels by ELISA.


METHODS
Single-centre university hospital.


METHODS
725 patients with ACS.


METHODS
Death and readmission for congestive heart failure.


RESULTS
During a median follow-up of 98 months, 235 patients (32%) died. Significant MR (grade >1 of 4) was found in 90 patients (12%). In a multivariate model including MR grade >1, LVEF <0.40 and BNP >373 pg/ml (75th percentile), MR was significantly associated with long-term mortality (HR 2.28, 95% CI 1.67 to 3.12; p<0.0001). When also adjusting for conventional risk factors, MR remained significantly associated with mortality (HR 1.53, 95% CI 1.06 to 2.19; p=0.02), as well as with congestive heart failure (HR 2.08, 95% CI 1.29 to 3.35; p=0.003).


CONCLUSIONS
MR is common in patients with ACS, provides independent risk information and should be taken into account in the evaluation of the long-term prognosis.
Persson
Anita
A
Department of Clinical Physiology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden
Hartford
Marianne
M
Herlitz
Johan
J
Karlsson
Thomas
T
Omland
Torbjørn
T
Caidahl
Kenneth
K
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain