title: Functional mitral regurgitation after a first non-ST segment elevation acute coronary syndrome: very-long-term follow-up, prognosis and contribution to left ventricular enlargement and atrial fibrillation development.
abstract: OBJECTIVE
  To assess the relationship between functional mitral regurgitation (MR) after a non-ST segment elevation acute coronary syndrome (NSTSEACS) and long-term prognosis, ventricular remodelling and further development of atrial fibrillation (AF), since functional MR is common after myocardial infarction.
  
  
  METHODS
  Prospective cohort study conducted in a tertiary referral centre.
  
  
  METHODS
  We prospectively studied 237 patients consecutively discharged in New York Heart Association class I-II (74% men; mean age 66.1 years) after a first NSTSEACS. All underwent an ECG the first week after admission and were echocardiographically and clinically followed-up (median 6.95 years).
  
  
  RESULTS
  MR was detected in 95 cases (40.1%) and became an independent risk factor for the development of heart failure (HF) and major adverse cardiovascular events (MACE) (per MR degree, HRHF 1.71, 95% CI 1.138 to 2.588, p=0.01; HRMACE 1.49, 95% CI 1.158 to 1.921, p=0.002). Left ventricular diastolic (grade I 12.7±40.7; grade II 26.8±12.4; grade III 46.3±50.9 mL, p=0.01) and systolic (grade I 10.4±37.3; grade II 10.12±12.7; grade III 36.8±46.0 mL, p=0.02) mean volumes were higher after follow-up in patients with MR, in proportion to the initial degree of MR. In the rhythm analysis (126 patients; previously excluding those with any history of AF) during follow-up, 11.4% of patients with degree I MR, 14.3% with degree II MR and 75% with degree III MR developed AF, while only 5.1% of those with degree 0 developed AF, p<0.001.
  
  
  CONCLUSIONS
  MR is common after an NSTSEACS. The presence and greater degree of MR confers a worse long-term prognosis after a first NSTSEACS. This can in part be explained by increased negative ventricular remodelling and increased occurrence of AF.
authors: Cardiovascular Institute, Hospital Clínico San Carlos, , Madrid, Spain.
authors: Iván J
authors: IJ
authors: Núñez-Gil
authors: Irene
authors: I
authors: Estrada
authors: Leopoldo
authors: L
authors: Pérez de Isla
authors: Gisela
authors: G
authors: Feltes
authors: José Alberto
authors: JA
authors: De Agustín
authors: David
authors: D
authors: Vivas
authors: Ana
authors: A
authors: Viana-Tejedor
authors: Javier
authors: J
authors: Escaned
authors: Fernando
authors: F
authors: Alfonso
authors: Pilar
authors: P
authors: Jiménez-Quevedo
authors: Miguel A
authors: MA
authors: García-Fernández
authors: Carlos
authors: C
authors: Macaya
authors: Antonio
authors: A
authors: Fernández-Ortiz
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D018450:Disease Progression; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D020257:Ventricular Remodeling