title: Impact of functional mitral regurgitation on right ventricular function and outcome in patients with right ventricular infarction.
abstract: Right ventricular (RV) infarction is associated with increased mortality. Functional mitral regurgitation (FMR) may complicate inferoposterior infarction with RV involvement leading to pulmonary hypertension and increased RV afterload, potentially exacerbating RV remodeling and dysfunction. We studied 179 patients with inferior wall left ventricular (LV) ST-elevation myocardial infarction and RV infarction. The presence and severity of FMR and RV function were assessed by echocardiography. FMR was diagnosed based on echocardiographic criteria and when the severity of regurgitation was ≥moderate. Eighteen patients (10.0%) had ≥moderate FMR. Estimated pulmonary artery systolic pressure was higher in patients with FMR than in patients without FMR (43 ± 10 vs 34 ± 10 mmHg, respectively, p = 0.002). RV systolic dysfunction was present in 76 patients (42.5%). FMR was a strong predictor of RV dysfunction (odds ratio 5.35, 95% confidence interval [CI] 1.65 to 17.48, p = 0.005) independent of reperfusion therapy. During a median follow-up of 4.1 years, 20 (12.4%) and 10 (55.6%) deaths occurred in patients with and without FMR, respectively (p <0.001). In a multivariable Cox regression model, compared with patients without FMR and with normal RV function, the adjusted hazard ratio for mortality was 1.02 in patients without FMR and with RV dysfunction (95% CI 0.39 to 2.69, p = 0.97) and 3.62 in patients with FMR with RV dysfunction (95% CI 1.33 to 9.85, p = 0.01). In conclusion, in patients with RV infarction, the development of concomitant hemodynamically significant FMR is associated with RV dysfunction. The risk for mortality is increased predominantly in patients with both RV dysfunction and FMR.
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Sergey
authors.initials: S
authors.lastname: Yalonetsky
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Eden
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lessick
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Michael
authors.initials: M
authors.lastname: Kapeliovich
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Dragu
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Diab
authors.initials: D
authors.lastname: Mutlak
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Shemy
authors.initials: S
authors.lastname: Carasso
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Reisner
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Agmon
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Haim
authors.initials: H
authors.lastname: Hammerman
authors.affiliation: Department of Cardiology, Rambam Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel. Electronic address: daronson@tx.technion.ac.il.
authors.forename: Doron
authors.initials: D
authors.lastname: Aronson
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology